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l�f <br /> NOTE: PULL ALL PERc�,fS (SEPTIC, WELL, ETC...) v�KE COPIES FOR FILE <br /> LAND USE REPORT APP# L)10-d0-10 <br /> EMD RECEIVED APP.REFERRAL: Z COMPLETE & SUBMIT BY a J ?/0 a <br /> DA ' DAT <br /> ATTN• L-aX14 4 f t /)l k)p`//A,� <br /> SITE ADDRESS: 23 <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 Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA /I CHECK <br /> OFFLIST., Proofread report? Correct L.4ND (ISE#? <br /> En 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />