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NOTE: PULL ALL PERM fS (SEPTIC, WELL, ETC...) ivtAKE COPIES FOR FILE <br /> LAND USE REPORT APP# C12 ,3�-�� <br /> EIID RECEIVED APP.REFERRAL: `14COMPLETE & SUBMIT BY �� -0 I <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: <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 Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA If CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />