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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M,,•KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> >\ , �, , <br /> EHD RECEIVED APP.REFERRAL: 7- COMPLETE & SUBMIT BY <br /> DATE � n I/� , DATE <br /> AT.TN: Cly eJr- 4 ( �'.c� r c _ - <br /> SITE ADDRESS: aj;e Cree,Z -1 KLA <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 /> r: <br /> k, -Public water: Public sewage: <br /> i" SUMMARY OR COMMENTS: <br /> t <br /> i <br />'=E <br /> I recommend: Approval- Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Q C.5, D <br /> Ce� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> pA` I CHECK QFl�' Pruafread reFort2, ,,f" 'aWCo err ct LA 01 USE <br /> eu ob ob Rev 1199 "� �Carrect CQNDITIQNFS)9� � Logged in <br />