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saljeB <br /> NOTE: PULL ALL PERIV'gS (SEPTIC, WELL, ETC...) Mr(KE COPIES FOR FILE <br /> LAND USE REPORT APP# /C�� ' 0.3- 399(19 <br /> EHD RECEIVED APP.REFERRAL: U 1 W COMPLETE & SUBMIT BY <br /> DAT <br /> DA <br /> ATTN: —e-CAA 2- � (P <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: !�w <br /> SUMMARY OR COMMENTS: <br /> © 1/ <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature Ll� <br /> *;*****:**********,���*�*��***:�*:�**�*,�x; xxx:xxx*xxxxK*xxxx**Kxxx***�***,��x,•�*�*��*,�,*�*��*� <br /> Supervisor/Lead Senior Comments: <br /> 0 J- <br /> A 11 0VV <br /> 17,111 <br /> 7 sd• / <br /> -�•*OIY ^°"�^`y.M+�.t o�ta•R. �0'I. 7'R�.GNf,n,MnL.G..O�,lr <br /> I. �� <br /> -V <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br /> E1106 06 Rev 1/99 <br />