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11C- <br /> NOTE: PULL ALL PERMi 1 S (SEPTIC, WELL, ETC...) A— KE COPIES FOR FILE <br /> LAND USE REPORT APP <br /> EIID RECEIVED APP.REFERRAL: p� COMPLETE & SUBMIT BY �/ <br /> DATE DA <br /> ATTN: <br /> SITE ADDRESS: a Y <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 R�OM�MENTS: <br /> oZa , d <br /> 46 <br /> o .� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor[Lead Senior Comments: <br /> c <br /> VAN 4 ^ a J <br /> R <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> �� OA vlI CHECK OFF L FST g _:- Propfread reparta Correct LAND USE# as <br /> " La ed in'.LAND USE BOOK? <br /> Correct CONDITl0�1'(Sj .gg ; <br /> EN 06 06 Rev 1199 _ <br />