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j 'NTOATE: PULL ALL PERM (SEPTIC, WELL, ETC-) E COPIES FOR FILE { <br /> LAND USE REPORT APP# <br /> f RAY ON VACATION <br /> exD RECEIVED APP.REFERRAL: d —3 va— COMPLETE & SUBMIT BY � t�2— 7hlo2—7/5/02 <br /> DA I /DATE <br /> ATTN: Je Irl ll i J440-4 <br /> SITE ADDRESS: <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 /> 617 <br /> I recommend: Approval Denial Continuance Inspector's Signa <br /> *it*****irX*fie*$rpt*�F*********�c**$cF*is*�E*aE*F*F****k*F**9c$r$*F ie kF k*�c*�cnk�•t�e�;eF�k id,$ >cXie - de*F dr is it irx9c is i�ir <br /> Supervisor/Lead Senior Comments: <br /> 6 7 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK'-' FF LIST Praofreari repor}�'s Correci LAND iISE#t 9 <br /> EH 06 06 Rev 1/99 3 Et r Correct CONDIT ID1V(S)P Logged in LA1VD USE BOOK? <br /> :. ` rnrzs€° .�fHa.s rd..:#:ab:, r,,-ti ?.`,�`�`-,,,,..,�-T vrs. .,;, <br />