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L Q3 <br /> NOTE: PULL ALL PERAfS (SEPTIC, WELL, ETC...) M7&E COPIES FOR FILE <br /> LAND USE REPORT APT# ✓� -Du <br /> EHD RECEIVED APP.REFERRAL: 10 11b O� COMPLETE & SUBMIT BY <br /> DA II DATE <br /> ATTN: l L / I J <br /> SITE ADDRESS: I a g 3 '> S f^ �'� YV� <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> All <br /> 010MC-d ti <br /> � 3 <br /> s <br /> r <br /> 4-3 �L <br /> SUPERVISORILEAD SENIOR APPROVAL: ,� ,na <br /> OA II CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH D6 06 Rev 1/99 u Correct CONDITION(S)? Logged in LAND USE BOOK? <br />