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NOTE: PULL ALL PERI<,..3 (SEPTIC, WELL, ETC...) YE COPIES FOR FILE `- p <br /> LAND USE REPORT APP# <br /> EIID RECEIVED APP.REFERRAL: <br /> 12-IqA COMPLETE & SUBMIT BY <br /> DATE DATE 1�3 <br /> ATTN: <br /> SITE ADDRESS: <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: Public sewage: <br /> SUMMARY OR COMMENTS: / <br /> /IQ.r� 0-4 Gi g <br /> I recommend: Approval `' Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> �nev� on <br /> SUPERVISOR/LEAD SENIOR APPROVAL: �- <br /> OA II CHECK OFF LIST., Proofread report? Correct LAND USE#? <br /> EH 06 00 Rev 1/99 Correct CONDITION(3)? Logged in LAND USE BOOK? <br />