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XQTX: PULL ALL PERA, S (SEPTIC, WELL, ETC-) KE COPIES FOR FILE <br /> LAND USE REPORT APP# 44--4l- 7 <br /> AS ' r-`-Dv1&EHD RECEIVED APP.REFERRAL: oZ0 ! COMPLETE SUBMIT BY <br /> DATE DATE <br /> ATTN: <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 /> showing population density, location of house, wind direction, etc.... <br /> Public water: 404a Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approva Denial Continuance Inspector's Sign r i <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 1I CH trIC OFF LISTf x ` Proa read reports x Correct LAND USE#? <br /> Co <br /> EH 06 06 Rev 1199 rrect CONDITIONS}7 ` Logged m LAND USE BOOK? <br /> Vit. � ,r - ..' ,., ..� -3T <br />