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j r <br />{! Jf <br /> NOTE: TULLALL PERM.1'S (SEPTIC, WELL, ETC...) Ir,AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHDRECEIVEDAPP.REFERRAL: q-13—ol COMPLETE & SUBMIT BY —(Z <br /> DATE ` DATE <br /> ATTN:" f•"A n L 1710A,�P� <br /> SITE ADDRESS: _._,503 5 j5. t4-r-m S96nb,n4 12�LL_� <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 /> showing population density,location of house, wind direction, etc.... <br /> Public water: � Public sewage: <br /> SUMMARY OR COMMENTS: <br /> r 4 1 r <br /> „� <br /> _. <br /> JOF <br /> 67 q( <br /> j- OZA <br /> I recommend: Approval Denial Continuance Inspector's Signature cri <br /> Supervisor/Lead Senior Comments: <br /> IE 0 iv <br /> zu� An <br /> R v J/ J o <br /> fi . t o <br /> 4 SUPERVISOR/LEAD SENIOR APPROVAL: <br /> ,OA!I Ck�ECIC OFt LIST > 'P.roofread repoi7?` 'sr Correct LAND USE#9 <br /> EH 06 06 Rei 1l99 Collect CQlV1?I?'I01Y(S)7 Lagged rn LAND USE BOOK <br />