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RMI SEPTIC WELL ETC... MAKE COPIES FOR FILE <br />NOTE: PULL ALL PE ( ) <br />LAND USE REPORT <br />7-i •n C - <br />APP# s%4 - 00 - �x -S;a <br />E}ID RECEIVED APP. REFERRAL: 10 -3J -O/ COMPLETE & SUBMIT BY I _ OV` OI <br />DATE DATE <br />ATTN: J" U "rl/ (" , bo re v-� <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: <br />Public sewage: <br />SUMMARY OR COMMENTS: <br />I recommend: Approval Denial Continuance Inspector's Signature <br />.� <br />*a2*��c9c�k*i'c9cdc�*x**9c�c�e�cde�'c�rdc*�k*irx�c�+ricsca'c�c*�YieoYik�c�kac�c�c�cic9c�c�'c*ic�e9e�'e9c*�c*i'c�F�F*�Fx�c*�c*�F�c�'t*�'e9e�e�c*�F*9t�ca'evR�'c**�k*fie <br />Supervisor/Lead Senior Comments: <br />SUPERVISOR/LEAD SENIOR APPROVAL: <br />EI -I 06 06 Rev 1/99 <br />OA II CHECK OFF LIST: Proofread report? Correct LAND USE #? <br />Correct CONDITION(S)? Logged in LAND USE BOOK? <br />