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NOTE: PULL ALL PERM-ti S (SEPTIC, WELL, ETC...) N ._-KE COPIES FOR FILE <br /> LAND USE REPORT APP# Salf <br /> EHD RECEIVED APP.REFERRAL: O —°C D—Ct COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: J e C �c -v--- <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 /> U � <br /> 13G <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. /,,-'proofread report? Correct LAND USE#? <br /> �orrect CONDITIONS))91 Logged 1n LAND USE BOOK? <br /> EH 06 06 Rev I/99 <br />