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y L <br /> 4 <br /> 'VOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...} MQE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHfl RECEIVER APP.REFERRAL: <br /> -d.6-01 COMPLETE & SUBMIT BY -7 - 0 -01 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: r <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 /> a <br /> showing population density, location of house,wind direction, etc.... <br />` Public water: Public sewage: <br /> SUMMARY OR COMMENTS: ` <br /> 4 V . <br /> _ o <br /> i <br /> 46 <br /> recommend: Approval Denial Continuance Inspector's Signat4**U444 <br /> "` <br /> t <br /> Supervisor/Lead Senior Comments: <br /> r 1 , <br />} �► {f s Y <br /> VV <br /> i f + <br /> .Q d4n" A <br /> f f.R i!• y t <br /> if <br /> �w 0 <br /> SUPERVISOR/LEAD SENT R APPR VAL: <br /> EF11- <br /> CHECK6P I QST'• LAND USE OOH?-LtO6.46[Z1199 <br />