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J NOTE: PULL ALL PERN, S (SEPTIC, WELL, ETC...) 1 E COPIES FOR FILE <br /> E; <br /> LAND USE REPORT APP# IA- -p <br /> EHD RECEIVED APP.REFERRAL: 011 COMPLETE & SUBMIT BYA PmBY*F <br /> DATE DATE <br /> ATTN: � <br /> SITE ADDRESS: 0/�g/0 g !� <br /> leal- <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 o ouse, wind direction, etc.... <br /> Public water: Public sewage: �--- <br /> SUMMARY OR COMMENTS: <br /> I <br /> .-G <br /> A <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> a f <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> SDA II+C'HECK OFIF t:1S7" � ,'Proojread:report?, , CorreclLAND USE <br /> EH 06 06 Rev 1199 EtE Correa C011�DITION(S)Yg'Y• Logged in LAND <br /> 'USE BOOK? <br /> i <br />