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NOTE: PULL AI, P 'S (SEPTIC, WELL, ETC...) .ISE COPIES FOR FILE <br /> if * 7""1"nye <br /> LAND USE REPORT APP# <br /> E IID RECEIVED APP.REFERRAL: 1 ' COMPLETE & SUBMIT BY <br /> DATE' ,� 2 DATE <br /> ATTN: L-erBl m t <br /> SITE ADDRESS: �y� �� ,5 f I to"") <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 /> z <br /> I recommend: Approval ✓' Denial Continuance Inspector's Signature— <br /> Supervisor/Lead <br /> ignatureSupervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> El 106 06 Rev 1/99 __Correct CONDITION(S)? Logged in LAND USE BOOK? <br />