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.' <br /> NOTE: PULL ALL PERU'S (SEPTIC, WELL, ETC...)CAKE COPIES IFOR FILE <br /> LAND USE REPORT APP <br /> #2a— <br /> ExD RECEIVED APP.REFERRAL:12/3 COMPLETE & SUBMIT BA nq P ' <br /> DAT `W (GATE N <br /> ATTN: <br /> SITE ADDRESS: b - Y /� <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 /> 1 <br /> I recommend: Approval ✓Denial Continuance Inspector's Sig <br /> kitkkk+rkkkaikirkk$rkkkkkiraFkdcdrirkkk$�rkafkickkkkair9tkkkoirkkkkkkkaickkaeAcka'ckarkk*ir4rkkdr $rkirir kkkaFirkkieickkkdsac <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECKVPFI/S7 Proofread reports s 3 Correct LA110 USE#9 <br /> EH U6 06 Rev��99 ` l� �' Correct CQNDITIDN(S} ��.= .Logged in LAND USE BOOKS ° ` <br />