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NOTE: PULL ALL PERI ; (SEPTIC, WELL, ETC...) R,..,.,(E COPIES FOR FILE <br /> LAND USE REPORT APP# Pt9 U - l 9 LS A2 <br /> rn RecEiveD ner.REFERRAL: / 2� COMPLETE & SUBMIT BY <br /> HP7 DATE <br /> �� y <br /> D E <br /> ATTN: P n n Ae 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 /> i <br /> U <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> d <br /> � ' ol <br /> D. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />