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KID <br /> NOTE: PULL ALL PERiViriS (SEPTIC, WELL, ETC...) 1 ,.KE COPIES FOR FILE <br /> iu <br /> / "i <br /> ° F <br /> LAND USE REPORT APP# U ��J <br /> EHD RECEIVED.APP.REFERRAL: Z <br /> MPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: U r <br /> SITE ADDRESS: r4 - L 9 <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 Signature <br /> *x*x�,�xxxx�*�xxxxxx*xxn*�Kx;****xxx,�xxx,�*x��*���*xnx*xxxnn*�*xxrx*x*nx;xxxxx�xx:�nnxxxxxx�x <br /> Supervisor/Lead Senior Comments: <br /> � f <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EII 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />