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NOTE: PULL ALL PER_i�..iTS (SEPTIC, WELL, ETC...)SAKE COPIES FOR FILE <br /> LAND USE REPORT APP# ,54 -W -�Q <br /> EHD RECEIVED APP.REFERRAL: 1 COMPLETE & SUBMIT BY � —Y / <br /> DATE 11 DATE <br /> ATTN: Q L cy Vm G <br /> SITE ADDRESS: ff(o <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: A Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 0 <br /> 2 �D <br /> I recommend: Approval Denial Continuance Inspector's Signature ' <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EFI 06 06 Rev 1-99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />