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,v <br /> NOTE: PULL ALL PERIV* ,S (SEPTIC, WELL, ETC...) NEKE COPIES FOR FILE <br /> LAND USE REPORT <br /> EIID RECEIVED APP.REFERRAL: — 5-0 COMPLETE & SUBMIT BY C� <br /> DATE Y� ( , n DATE <br /> ATTN: , - i C I'_ l- <br /> SITE ADDRESS: <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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> . 6 <br /> a2. <br /> I recommend: Approval Denial Continuance Inspector's Signature—IA- <br /> Supervisor/Lead Senior Comments: <br /> 6 <br /> C <br /> •, o <br /> 117,41 2, <br /> 0 r <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA If CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 11 11 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />