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0C IJ <br /> NOTE": PULL ALL PERN.'S (SEPTIC, WELL, ETC...) I.KE COPIES FOR FILE <br /> LAND USE REPORT APP# .514 -DI - a5( ! E) <br /> EHD RECEIVED APP.REFERRAL: 11 a6--Oz-l- COMPLETE & SUBMIT BY I a — //` O a <br /> DATE DATE <br /> ATTN: Je—n t 1 I iLL ,\--l �J <br /> SITE ADDRESS: L{ I ef 1) 11 r I QC S4, C--^-, C- <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 Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />