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NOTE: PULL ALL PER1V)TS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP <br /> EHD RECEIVED APP.REFERRAL: II ' COMPLETE & SUBMIT BY 12 J/3 --Q 0 <br /> DATE DATE <br /> ATTN: D PIIS /l'' 7 <br /> SITE ADDRESS: 10- o n1 1A I/- -, ,C /Z d <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 /> 0V <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 11 O.) <br /> 1t <br /> v <br /> SUPERVISOR/LEAD SENIOR APPROVAL- <br /> FOA II CHECK OFF LIST: _Proofread report? _Correct LAND USE t!? <br /> EH 06 06 Rev 1/99 — <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />