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NOTE: PULL ALL PERM I'S (SEPTIC, WELL, ETC...) MI&E COPIES FOR FILE <br /> -f--0 / -/ �SCr�J <br /> LAND USE REPORT APP# <br /> EIIU RECEIVED APP.REFERRAL: O 0] COMPLETE & SUBMIT BY <br /> DA: . "' <br /> ATTN: - <br /> SITE ADDRESS: 12) 1L i a ��- -- --T- <br /> rj <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 /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />