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NOTE: PULL ALL PERAkrfS (SEPTIC, WELL, ETC...) RAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: -3- a �'-01 COMPLETE & SUBMIT BY (4 — ( -? —Q <br /> DATE DATE <br /> ATTN: y- <br /> SITE ADDRESS: a S(o S T r P a 1e-d. (� S cam- L o n <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 /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior _ ents: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST., Proofread report? Correct LAND USE#k? <br /> Eu 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />