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NOTE: PULL ALL PERMV1f§ (SEPTIC, WELL ETC...) 1V*qKE COPIES FOR FILE <br /> LAND USE REPORT1APP# <br /> ] [ <br /> END RECEIVED APP.REFERRAL: - /U -0I COMPLETE & SUBMIT BY DAT <br /> DATE / <br /> SITE ADDRESS: f C) <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: <br /> � Public sewage: �— <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> J <br /> r 18,57-* <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA Il CHECK OFF LIST: _Proofread report? _ Correct LAND USE#? <br /> EH 06 06 Rev irov Correct CONDITION(S)? Logged in LAND USE BOOK? <br />