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NOTE: PULL ALL PERI,�i S (SEPTIC, WELL, ETC...) :EKE COPIES FOR FILE <br /> LAND USE REPORT APP# Srf_+ -f; l - <br /> EIID RECEIVED APP.REFERRAL: (D I b COMPLETE & SUBMIT BY `4' " / q -- <br /> DA E J� ,, _ n ` DATE <br /> SITE ADDRESS: { 5& 1,4 vlarlAOx eCl SO4,,j�/^ <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 /> }� IaEli CA51N� j{Iyp L9oN1>Ul7� cN 4Ai— wikls4 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Supervisor/Lead Sgnior Comments: <br /> ; <br /> ate' <br /> ■ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA/!CHECK <br /> 'LIST. Proofread report? Correct LAND USE#T <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />