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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> ti <br /> LAND USE REPORT APP# LA-- q Ll - (P — <br /> ERD RECEIVED APP.REFERRAL:\ I ) C! COMPLETE & SUBMIT BDATE 1 DATE <br /> ATTN: ,I V)& <br /> SITE ADDRESS: O <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: -b Public sewage: U <br /> SUMMARY OR COMMENTS: <br /> O tr a e <br /> I recommend: ApprovalDenial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> i� <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 14 <br /> OA 11 CHECK OFF,L&T , Y ranfreird repo Garrett SAND USE#?' <br /> EH 06 06 Rev 1/99 Correct CONDITTON{S)F Logged rn LAND USE BDDK� <br /> - <br /> C <br />