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- oole�. <br /> 'NOTE: PULL ALL PERF S (SEPTIC, WELL, ETC...) XE COPIES FOR FILE <br /> 4VtS"-0y1,5 o� <br /> LAND USE REPORT APP# Ig70r0 <br /> EIID RECEIVED APP.REFERRAL: I' — '✓ COMPLETE & SUBMIT BY J,2 — /V —y <br /> DATE nn DATE <br /> ATTN• <br /> SITE ADDRESS: a/3 c <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: j, �tf [,J <br /> J <br /> SUMMARY OR COMMENTS: <br /> Z <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 /> PF106 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />