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/N TE:,,PLiT , ALL PERl1 S (SEPTIC, WELL, ETC...}'�� KE COPIES FOR FILE <br /> y- <br /> LAND USE REPORT APP# L-A D Co <br /> K- <br /> DATE <br /> EIID RECEIVEDAPP.REFERRAL: p COMPLETE & SUBMIT BY ASA DATE <br /> ATTN: <br /> SITE ADDRESS: 6 � c o 1 <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: ti <br /> I recommend: Approval Denial Continuance Inspector's Signaturer?�4 121a4 <br /> Supervisor/Lead Senior Comments: <br /> I1 <br /> 1 <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> oA 11 CHEG'K"o `t�rsr a -. -+Proofread report ''v �Gnrrect ItI ND,:USE#9 <br /> 11Rcv 1199 � Correct CONDITfON(S)? Logged in L 4X6 USEi6bk <br /> 6 z¢ <br /> -....e� . <br />