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k4 J/ ;t�,-6 1 e-A it kj <br /> NOTE: PULL ALL PER .4rS (SEPTIC, WELL, ETC-) N-AKE COPIES FOR FILE <br /> LAND USE REPORT APP#_ /04 —0-a - 3 7 5 ?" <br /> rxa RECEIVED APP.REFERRAL- 1�0 o0Z COMPLETE & SUBMIT BY Z <br /> DAT <br /> DATE <br /> ATTN: 6t <br /> SITE ADDRESS: Li <br /> �- <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 reap of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> dcaY3�x�rak�e�e9r4e9cv4oExicirie�r�nkvY�caF�r�Fa'cde�F-1e�F�c-kdc�r�c�Fde9c�exvF9:9t�c*3ck�c9cxirieie�>t�cievcieie�eiexieie�F9e�F9t�t9c:E�skiei�ie9exireFxk�c9t�t9t�'t:EtE <br /> Supervisor/Lead S for Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFFLIST � Proofread.report a `. Correct L 41VD USE#9 <br /> EH 06 06 Rev 1199 e y `i8 Correct COIVDITION(S)?` Logge to LAND USE BOOK? <br />