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LG <br /> NOTE: PULL ALL PEFc�ITS (SEPTIC, WELL, ETC...,-,IAKE COPIES FOR FILE <br /> LAND USE REPORT APP# / - 0 <br /> EHD RECEIVED APP.REFERK-U: <br /> COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• �Ai'1 <br /> SITE ADDRESS: I L L J2ti ,V <br /> In completing the Land Use investigation, draw all Public He4th 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 /> r <br /> of <br /> .4r -- 110Tk 5 4 L=r) ermT r sS <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> ay <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> -L U <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />