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NOTE:. PULL ALL PERNh.S (SEPTIC, WELL, ETC...) I —,eKCE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EUD RECEIVED.APP.REFERRAL: COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: / <br /> SITE ADDRESS: l <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 /> N1zijPcegPublic water:V&W Public sw sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />