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NOTk: PULL ALL PERIF ?'S (SEPTIC, WELL, ETC...) ? aKE COPIES FOR FILE <br /> » T <br /> LAND USE REPORT APP#_ jinS) <br /> k-1;2 -6-,) - <br /> EIID RECEIVED APP.REFERRAL: O -1;2 -6 Z COMPLETE & SUBMIT BY <br /> DATE G� ' DATE <br /> ATTN: `j o_i:-e._ 61aof <br /> SITE ADDRESS: ) Oed , <br /> In completing the Land Use investigation, draw all PuVie 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 /> *xxxxKx��KxxKx��x*xR*xxx**x*xxxxxx*x*; x�xxxFxx�x�x*:�xx+*Ksx�xxK�x;,�x,�K*+x*x*xxx;xxxxxx�K*x <br /> Supervisor/Lead Senior Comments: yy� <br /> a d"`� ' v <br /> rvy � <br /> v" 4 <br /> r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EII 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />