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�l7 <br /> NOTE: PULL ALL PERIV.,.S (SEPTIC, WELL, ETC...) n",:KE COPIES FOR FILE <br /> LA-o1-77 <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 10` —�1 _ COMPLETE & SUBMIT BYASAP /� <br /> 1 i C I <br /> D! DATE <br /> ATTN: JEFF FISHER <br /> 23131 S.OLIVE RD. <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 /> I recommend: Approval_ Denial Continuance Inspector's Signat <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ' <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />