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• R <br /> NOME: PULL ALL PERU. 'S (SEPTIC, WELL, ETC...) XE COPIES FOR FILE <br /> LAND USE REPORT APP# MS ` �e `02 <br /> E11D RECEIVED APP.REFERRAL: T Q COMPLETE & SUBMIT BY 9ll X10 <br /> DATE DATE <br /> ATTN: J-/t" Vah igUren- <br /> SITE ADDRESS: /7,9S'/ S • WC-torN kOad AO-kbtfe- <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 /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> AA 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 />