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NOTE: PULL ALL PERIWITS (SEPTIC, WELL, ETC...) XfAKE COPIES FOR FILE <br /> LAND USE REPORT APP# S /q - q L7 <br /> EHD RECEIVED.APP.REFERRAL: 1 �—q —6(q COMPLETE & SUBMIT BY -- 7' 9 9 <br /> DATE DATE <br /> ATTN: J ( �� she r <br /> SITE ADDRESS: --) !S J A `7 E, �i J e r k oad ESca I a 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: /J# Public sewage: AJA <br /> SUMMARY OR COMMENTS: <br /> Db � FL w <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST. Proofread reportO. Correct L4ND USE#? <br /> E1106 06 Rev 1;99 Correct CONDITION(S)? Logged w LAND USE BOOK? <br />