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NOTE: PULL ALL PEG*S (SEPTIC, WELL, ETC."KE COPIES FOR FILE <br /> LAND USE REPORT APP# 5/1-01 4-1 <br /> MID RECEIVED APP.REFERRAL: 1 I4 COMPLETE & SUBMIT BY_L( - 4 0 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 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 /> -© <br /> ioe <br /> 1 <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 /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />