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NOTE: PULL ALL PERK ffTS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 5 - r _ <br /> EHD RECEIVED APP.REFERRAL: I d -61 COMPLETE & SUBMIT BY I — 16 - 61 <br /> DATE DATE <br /> ATTN: k <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public ealth 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 /> V VIP <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 /> EH 06 06 Rev 1/99 —Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />