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!&eTE: PULL ALL PERT S (SEPTIC, WELL, ETC...) . KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APA.REFERRAL: �o�l Q/ COMPLETE & SUBMIT AP- yi: <br /> DATE <br /> DATE1 a - a� � l -' <br /> ATTN: leWc Gr�A -rit <br /> SITE ADDRESS: Sa 9!5- F, Ver1;AS Ale,, AIRpife ca. <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: Approval Denial Continuance Inspector's Sign <br /> Supervisor/Lead Senior Comments: <br /> i <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA lI 'H IC OFF,LIST 1'raofceUd reportP Correct LAND USE#?:, <br /> EH 06 06 Rev 1/99 � Carrect C4NDIT1'ON(S)' LoggBaC t4 I.A1VD USE BODKP <br />