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NOTE: iPULL ALL PERNv...rS (SEPTIC, WELL, ETC...) .EKE COPIES FOR FILE <br /> LAND USE REPORT l?/1 APP# PP- l.L O I i Z� `01`OF <br /> EHD RECEIVED APP.REFERRAL: u y S-D/ COMPLETE & SUBMIT BY 9 "1 <br /> DATE n D TE <br /> I <br /> ATTN: <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health fact 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 /> J <br /> ILA <br /> 0. <br /> .'f. Q <br /> I recommend: Approval Denial Continuance Inspector's Si nature L c <br /> Supervisor[Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> ff <br /> H CHECK OFF LIST: Proofread report? _Correct LAND USE#? <br /> [H 06 06 Rev 1/99 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />