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' ` MAKE COPIES FOR FILE <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC... _ <br /> T APP#_-p�- -�� - ®�(S F1� <br /> LAND USE REPO IT . <br /> NE (� COMPLETE & SUBMIT BYaEHD RECEIVED APP.REFERRAL:DA ATE <br /> ATTN: v 1 b <br /> SITE ADDRESS: 'r <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 /> Aw <br /> 1" <br /> " dS <br /> R,fie deec*o4cm�4cmfe$ekn�dr 9:e kAik dpk�pxrno9vc�ca,Fl Denial <br /> enial xnit 9:,�c 9cContinuance <br /> � nFxI�nc�se�r 4er�cct�oxr,@'4sc Signature�ki�c <br /> n�atuarre <br /> ,Exit it is�r�e ie�k ,F is ac�c�e ak�c <br /> SupervisorlLead Senior Comments: <br /> 4 <br /> �/¢'�"/' yes. <br /> C <br /> F � <br /> . x-03 3 <br /> SUEERVISORILEAD SENIOR APPROVAL: 0-7 <br /> LAND USE LOG { <br /> Al ON CALENDAR <br /> 4 IT CHECIf OFF IST " Pr`oafread report ` Correct <br /> ���n Correct CQNDITIOiV(S) ogged rn LAND USE BU+OK� <br />