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_ L6 <br /> NOTE:` PULL ALL PER 'S (SEPTIC, WELL, ETC...) fKE COPIES FOR FILE <br /> LAND USE REPORT APP# L <br /> Ell RECEIVED APP.REFERRAL: L COMPLETE & SUBMIT BY A P PVI- <br /> DATE DATE <br /> ATTN: G -� r <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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> a <br /> ii <br /> 1 <br /> I recommend: Approvai Denial; Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> t``OA-11 CHECK OFFLISTProofread report?, Correct LAND USE#? <br /> EH 06 06 Rev 1/99 � F�z�orrecf CONDITION{S)? Logged in LAND USE BOOK? <br /> .p ,..,tic. •- .. �„ <br />