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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MSE COPIES FOR FILE <br /> LAND USE REPORT APP <br /> EI-ID RECEIVED APP.REFERRAL: 6, —/` lief/ COMPLETE & SUBMIT BY )4SZIe -25 -C/ <br /> DATE DATE <br /> ATTN: �i✓I� <br /> SITE ADDRESS: I S S 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 density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> ��. <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> wy <br /> S-0 0 <br /> all <br /> " 'Lu <br /> w � <br /> i <br /> Y <br /> SUPER�R/LEADIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> E1106 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />