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U�NGTE: PULL ALL PERN,. S (SEPTIC, WELL, ETC...) 11l.�XE COPIES FOR FILE <br /> LAND USE REPORT APP# OX-qj(- 9-W isej) <br /> EHD RECEIVED APP.REFERRAL: 4/q/Q)— COMPLETE & SUBMIT BY )—002 <br /> AAT DATE <br /> ATTN: <br /> SITE ADDRESS: (a �'{ OS <br /> In.completing the Land Use investigation, draw all Public Health factors on the exh bit (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 Signaturei <br /> **** <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ,. <br /> OA II CHECKOFF LIST Proofread report Correct L41V0USE#9 <br /> EH 06 06 Rev 1199Correct ged In LAND USE BOOK? <br />