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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MISE COPIES FOR FILE <br /> APP# ,� D a -og 620 S ) <br /> LAND USE REPORT -P <br /> EIID RECEIVED APP.REFERRAL: 1 -2a-0a�l- COMPLETE & SUBMIT BY " 6 -o a <br /> DATE DATE <br /> ATTN: CD r 1 - 6 l <br /> SITE ADDRESS: Tr <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: 1-- I Public sewage: �d <br /> SUMMARY OR COMMENTS: <br /> 7 <br /> I recommend: Approval Denial Continuance Inspector's Signature C <br /> Supervisor/Lead Senior Comments: <br /> J <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 />