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I <br /> NOTE: PULL ALL PERM `fit' (SEPTIC, WELL, ETC.. COPIES FOR FILE <br /> L <br /> I <br /> LAND USE REPORT APP# S/4 K <br /> 1 d c,�8- � COMPLETE & SUBMIT BY ©a <br /> E'�iD RECEIVED APP.REFERRAL: ' <br /> DATE DATE <br /> ATTN: J Q. <br /> SITE ADDRESS: ?)4� �V E n� L <br /> .I <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, wind4Hrection, etc.... <br /> Public sewage:, rJ <br /> Public water: <br /> SUMMARY OR COMMENTS: <br /> r <br /> M -) <br /> I <br /> Ih� <br /> I! <br /> 1 I� <br /> I recommend: Approval Denial Continuance Inspector's Signatur _— <br /> r <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> 1 <br /> a : o s— <br /> 'f <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> pA II CHLCTCe�FF LISProo rsaf re arl'? 3 Garro DANA flSE <br /> a � , arrest (SNDITIQN(S)? � Lngg�d in.SAND Z1SE <br /> EH 06 06 Rev 1199 <br />