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NOTE: PULL ALL PERNMrS (SEPTIC, WELL, ETC...) IWAKE COPIES FOR FILE <br /> �G 33 6!23 <br /> LAND USE REPORT APP-4 <br /> EHD RECEIVED APP.REFERR.-%L: S— ? —W COMPLETE & SUBMIT BY C1 -7 r 7 <br /> DATE DATE <br /> ATTN: S' <br /> SITEADDRESS: <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: U- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 6V-1 0 8 <br /> O 3 <br /> I recommend: Approval x Denial Continuance Inspector's Signature -454e,.",1,A'-' x <br /> Supervisor/Lead Senior Comments: <br /> CA <br /> 077- <br /> SUPERVISOR/LEAD <br /> ZSUPERVISOR/LEAD SENIOR APPROVAL: , <br /> OA II CHECK OFF LIST.• Proofread repo l Correct L4ND USE#? <br /> EH 06 06 Rev 1/99 J/Correct CONDITION(S)? Logged in LAND USE BOOK? <br />