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NOTE: PULL ALL PERNInS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT <br /> APP �/� - io�j y7 lS <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY &J Z l / <br /> DA DATE <br /> ATE <br /> C <br /> SITE ADDRESS: r / /✓ / 6 d& �^O � Syc� A <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 Signature <br /> �c is isx it is icxi;icr.x�c ie ac is icx is rr>cxic icx�F ic¢r rcx�c�cxi�xx*ix 3r aFxrcx9cx�c x'7c�cxic is�cxicxxycxicz is�F x>ci�:<xx9cxr'c is>'cx Kxicxzic is r.zis icx rcx�c <br /> Supervisor/Lead Senior Comments: <br /> Vu AIP <br /> C �;L <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 4LL <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rev.1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />