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`NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EFiB RECEIVER APP.REFERRAL: <br /> ' 9-17-00 COMPLETE & SUBMIT BY h[.S I�} r7—'�6 -d 0 <br /> DATE DATE. <br /> ATTN: <br /> SITE ADDRESS: a-0 <br /> I� <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 derisity, location of house, wind direction, etc.... <br /> Public water: JaI _Public sewage: <br /> SUMMARY OR COMMENTS: <br /> `D <br /> i <br /> II <br /> .F <br /> i� <br /> N <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ,**,*,4( <br /> Supervisor/Lead Senior Comments: <br /> ii <br /> N <br /> N <br /> II <br /> N <br /> SUPERVISOR/LEAD SENIOR APPROVAL: iv • <br /> OA 11 Ci�a(ECKPPfO�ST, $ jPraofread ��eCorrect LAND' �� ,EH 05 06 Rev 1199 � e«�'. � �� ,� '� � <br />