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NOTE: PULL ALL PERS (SEPTIC, WELL, ETC...) k,-&E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 11161,Q5 COMPLETE & SUBMIT BY �0�� <br /> DATE D E <br /> ATTN: J Q..n Il <br /> SITE ADDRESS: y �/l7 5 < �� 9� " 2 <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 <br /> .Gx� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: Al X13 <br /> d Irl Jl <br /> o .r ' <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA/I CHECK OFF LIST.• _Proofread report? _Correct LAND USE V <br /> Correct CONDITION(,,;)? Logged in LAND USE BOOK? <br /> Ef 106 06 Rev 1199 <br />