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TN <br /> te NOTE:`PULL ALL PER*.S (SEPTIC, WELL, ETC... KE COPIES FOR FILE <br /> LAND USE REPORT APP# S+ -() I -j-q <br /> EHD RECEIVED APP.REFERRAL: 'f7 COMPLETE & SUBMIT BY —J � —O l <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: a N <br /> In completing the Land Use investigation, draw all Public Aealth 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 /> .+ J <br /> 2 o Z <br /> J 7 <br /> I recommend: Approval Denial Continuance Inspector's Signature f � <br /> S pervisor/Lead Senior Comments: <br /> a <br /> 40 J•/z d .C� .ti Gam/✓!� <br /> C . lay -Z <br /> f° <br /> 401 r <br /> 1 <br /> dip- <br /> SUPERVISOR/LEAD <br /> SUPERVISOR/LEAD SENIOR A ROVAL: <br /> !671r <br /> OA II CHECK 0,&LIST.- Proofread report? Correct LAND USE#? <br /> UH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> ! r <br />