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"NOTE: PULk ALL PERP S (SEPTIC, WELL, ETC...) I KE COPIES FOR FILE <br /> LAND USE REPORT APP# L a <br /> f <br /> EI-ID RECEIVED APP.REFERRAL: _ 1 21 COMPLETE & SUBMIT BYA:L�6A � <br /> DATE pp <br /> ATTN: J vS ku r ) <br /> SITE ADDRESS: 4r:A)V , <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 /> rm-- � <br /> Public water: Public sewage.- <br /> SUMMARY <br /> ewage:SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signatures <br /> Supervisor/Lead Senior Comments: <br /> 9 � <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 1I CI�ECK OFFLIST., Proofread report? _ Correct LAND USE,#q< <br /> Eu 06 06 Rev 1199 � �A�Correcf C4IVDITION(S)Pei Logged 1n LAND SE BOO ? �9 <br />