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'l <br /> ,N6TE: PULL ALL PERK 'S (SEPTIC, WELL, ETC...) A -CE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EI-ID RECEIVED APP.REFERRAL: 5 , k-, COMPLETE & SUBMIT BY <br /> DATC DATE <br /> ATTN: /, <br /> SITE ADDRESS: s , <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 /> oc is*9cXz9c�Ex�'c 3c�c*x9c ie�F n'c�nF is�t is�'c�'c�cxxic is is is is is icxic�c�cxxxx��c�'c�'c�F 4cx�'c�'cx�k icxic is is is ixxic�cxx�c is is r,xic is is is z>cx�c 9cx4c is is is is is is�c�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />