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NOTE: PULL ALL PER?VtY.TS (SEPTIC, WELL, ETC-) N AKE COPIES FOR FILE <br /> LAND USE REPORT APP# -00- 91,1 <br /> may, <br /> EHD RECEIVED APP.REFERRAL: ! -X2400 COMPLETE & SUBMIT BY / <br /> DATE DATE <br /> ATTN: meg I_Zp_l e ,� <br /> SITE ADDRESS: Y <br /> In completing the Land Use investigation, draw all Public 6ealth factors on the,exhibit G.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 /> k .` <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> KaAed' -3 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> t 'OA IT CFIEC�GFFL�S� € Proofread rnrt� Correct LAND USE,#9 _" <br /> EH ob ob Rev 1/99 <br /> ��� �` F Correct e(?�VDITION(S)? � Logge'd rn LAND USE BOOK?,�Mb,", <br />