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'J <br /> NOTE: PULL ALL PERA...S (SEPTIC, WELL, ETC...) ' ,,KE COPIES FOR FILE <br /> LAND USE REPORT <br /> J �Euo RECEIVED AVP.REFERRAL: C' I 'L)I COMPLETE & SUBMIT BY <br /> DATE _ rr DATE <br /> ATTN: J <br /> SITE ADDRESS: <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 /> sul (A�xn' STUDY <br /> Lt7cAT� -TI+(,- I�Wr]Ma til CAI kME /F Tf1E Gi�GL /s wirtiiv 'Ka�osr� <br /> �b"Cf T AfizL�k 22 " 0 2 —�C�s-r in��� �� T�8G� � ,�c/lTi�i11":✓ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> ✓ <br /> o . <br /> SUPERVISOR/LEAD SENIOR APPROVAL: " <br /> r / oa4oy <br /> OA II CHECK OFF LIST.- _Proofread report? Correct LAND USE#? <br /> ED 06 06 Rev 1/99 _'Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />