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7 <br /> NOTE: PULL ALL PE' q �(SEPTIC, WELL, ETC. o .E COPIES FOR FILE <br /> LAND USE REPORT APP# --O <br /> EI"ID RECEIVED APP.REFERRAL: !J- 6 -0i <br /> COMPLETE & SUBMIT BY <br /> DATE �- �F- E . <br /> DA ^� <br /> ATTN: � e-S <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 /> li showing population density, location of house, wind direction, etc.... <br /> Public water: ,�..--- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> CIECK OF1 LIST" " Proofread report? Correct LAND USS;#.. <br /> EH 06 06 Rev 1/99 a aP ry <br /> r `> Correct CONDI7lON(S) " dogged t>1 LAND USE BOOK? <br /> �•a . <br />