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,_4 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP-91 Irl -mA <br /> EHD RECEIVED APP.REFERRAL: J "ay-qq COMPLETE & SUBMIT BY A7 19 <br /> DATE DATE <br /> ATTN• . I" �)2 0 <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health actors on the exhibit(Le.: sewage disposal, <br /> water supplies, etc...)_ Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, locat' use, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> A2��2 <br /> on <br /> I recommend: Approval Denial Continuance Inspector's Signature / <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA7LCHECK'OFF IST.• Proofread report? •t`Correct�LANDUSE#9 <br /> Eli 06 06 Rev 1/99 " Correct CONDITION(Sj�. Logged.to LAND USE BOQK' <br />