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NOTE: PULL ALL PERN� fS (SEPTIC, WELL, ETC...) _`.EKE COPIES FOR FILES S <br /> LAND USE REPORT APP# <br /> E.ID RECEIVED APP.REFERRAL: q 6l COMPLETE & SUBMIT BY zz/41O <br /> DA E DATE <br /> ATTs . GeLr rrI a n �'d• �t�1.. <br /> SITE ADDRESS: <br /> i <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage dI osal, <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 /> Supervisor/Lead Senior Comments: <br /> a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA IL CHECK OFF LIST. , Proofread report? _Correct LAND USE#? <br /> EII 06 06 Rev 1199 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />