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NOTE: PULL ALL PER1V,,.--'S (SEPTIC, WELL, ETC...) P_,,KE COPIES FOR FILE <br /> y <br /> LAND USE REPORT APP# S -ho r,-ne EXLj ,s4-yj <br /> MID RECEIVED APP.REFERRAL: -> v0` COMPLETE & SUBMIT BY 0/ <br /> DATE DATE <br /> ATTN: r <br /> SITE ADDRESS: )/C t2 d. A Cel"v1 o <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 /> dye <br /> ij 0� <br /> If:oS <br /> I r`v 7 <br /> �I vQ <br /> 22: I <br /> C-- <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <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 />