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s /Jq <br /> NOTE: PULL ALL PERNPTS (SEPTIC, WELL, ETC...) ._AKE COPIES FOR FILE <br /> LAND USE REPORT APP# /� `03- 6_�a Sd) <br /> EHD RECEIVED APP.REFERRAL: l COMPLETE & SUBMIT BY oZ °2 63 <br /> DAT9 <br /> ( DATE <br /> ATTN: � ) <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all P lic 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: A� Public sewage: Ino <br /> SUMMARY OR COMMENTS: <br /> a d� <br /> aa� d <br /> I recommend: Approval Denial Continuance InspectoASi�gnatur �ex�C'e�YxXX �'c*�c dC iXx <br /> Supervisor/Lead Senior Comments: <br /> yd _ S <br /> CA <br /> � 0 Q. n <br /> � <br /> aa:o <br /> r" 211 , <br /> SUPERVISOR/LEAD SENIOR AP RO AL: <br /> `1 CHECK OFF LIST. proofread report? Correct LAND USE 0. <br /> ��✓Ll�t1'L <br /> OA I Logged in LAND USE BOOK? <br /> Correct C014DITIO,N(S). gg <br /> FI 106 06 Rev 1/99 _. <br />