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LG <br /> NOTE: PULL ALL PERT TS (SEPTIC, WELL, ETC...) ,,,,FAKE COPIES FOR FILE <br /> LAND USE REPORT A P P# q <br /> EHD RECEIVED APP.REFERRAL: I COMPLETE & SUBMIT BY <br /> E)vv <br /> DA <br /> DATE <br /> ATTN: C-12 r I' ��Al <br /> SITE ADDRESS: L C qo, S � - " f c �► �' ; a fl �,Awl <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: Approva Denial Continuance Inspector's Signatu <br /> xzicxic is i�zxxicx�c is icxocxic icxxic 9c�Fxicxxx�c�cx is�cxic is icxicx9cx�c�c icz is icx�cxacx�cxic icx xic is�cxicx�c�c xic is is 9c�'c xx�c>cxxic icxzx r.xx <br /> Supervisor/L,ead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />