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NOTE: PULL ALL PER1V1,_,5 (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> END RECEIVED APP.REFERRAL: q -/a--0j COMPLETE & SUBMIT BY AR A r 1 ---o <br /> DATE 6MATE <br /> ATTN: Gl <br /> SITE ADDRESS: J�3 — <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.. sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: �Inyj g� Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signatur - <br /> Supervisor/Lead Senior Comments: <br /> / 1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 4 <br /> OA 11 CHECK OFF LIST. I Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _ - Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />