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NOTE: PULL ALL P1 _ FS (SEPTIC, WELL, ETC...) .,-.,EKE COPIES FOR FILE <br /> )&,.Ir s,Jvt,9� <br /> LAND USE REPORT APP#�y y( -�j �/-/� /3p/�Ni4.� r <br /> EHD RECEIVED APP.REFERRAL: y I—oQ COMPLETE & SUBMIT BY 16 -0 -1 <br /> DATE DATE <br /> ATTN: ti — M✓Q-(Ie,r— <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit .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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 1126 <br /> OA/I CHECK <br /> OFFLIST. Proofread report? _Correct LAND USE#? <br /> EF105 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />