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' JIMM i 1/" <br /> 4-NOTE*: �>,LL PER (SEPTIC, WELL, ETC...) KE COPIES FOR FILE <br /> SA-01-77 <br /> LAND USE REPORT APP# <br /> EIID RECEIVED API'.REFERRAL: I COMPLETE & SUBMIT BY 1 --c-) <br /> DATE DATE <br /> ATTN: /10r— <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Heal'K 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: -r--- <br /> SUMMARY OR COMMENTS: <br /> 1 <br /> I recommend: Approval ol' Denial Continuance Inspector's Signaturel`- � 5^-2e <br /> ?, <br /> awl <br /> Supervisor/Lead Senior Comments: <br /> a Y <br /> l ' <br /> 0 –�®do <br /> 97 <br /> at <br /> lI r z • <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> u. 11:d S r, t <br /> OA'II CiIECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EFI 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />