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NOTE: PULL ALL PER11�S (SEPTIC, WELL, ETC...) IKE COPIES FOR FILE <br /> Pie <br /> LAND USE REPORT APP#5 <br /> EIID RECEIVED APP.REFERRAL: A�-�6 -01 — COMPLETE S: SUBMIT BY I <br /> I DATE <br /> ATTN: `I <br /> SITE ADDRESS: I O I E IMr} �r- L) T <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: I <br /> e <br /> , <br /> �i <br /> i <br /> F <br /> / ' f <br /> I recommend• Approval )� Denial Continuance Inspector's Signat Y <br /> Supervisor/Lead Senior Comments: <br /> C // ' 03 aend t �,� V <br /> �.0Y <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev v9q _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />