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SS <br /> NOTE; PULL ALL PE�,.,i,. d (SEPTIC, WELL, ETC...".I,.,XE COPIES FOR FILE <br /> LAND USE REPORTll APP# <br /> EIID RECEIVED APP.REFERRAL: `VL '0/ COMPLETE & SUBMIT BY <br /> DATEDATE <br /> �/� <br /> ATTN: i�l�1� I � WQ I(f1 c �-- <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: se age 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 /> l "0I1f11T)U/Jb Iy/T/,4 SSI <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> 64 , <br /> V-0'n a / <br /> hit cf� A't Co' A�� 4N6Yr y� ./ a,/PJ4 �ydifv7y�sf <br /> 401 <br /> 'tilfl- h2 <br /> iv,t <br /> SUPERVISOR/LEAD SENIOR APPROVAL: / <br /> OA II CHECK OFFLIST. _Proofread report? Correct LAND USE#? <br /> GH 06 06 Rev 1199 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />