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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) Mr(KE COPIES FOR FILE <br /> LAND USE REPORT APP#p�} - 0 - A SLA <br /> EHD RECEIR"ED APP.REFERRAL: / l M COMPLETE & SUBMIT BY U <br /> DAT n/ _ DATtS M- <br /> ATTN: i (-k- C^r l <br /> SITE ADDRESS: Il v) —f2PM�� <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: A0---r Public sewage: <br /> SUMMARY OR COMMENTS: <br /> L y <br /> � � U <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 1/CHECK OFF LIST: _Proofread report? Correct=BOOK? <br /> Correct CONDITION(S)? _Logged in LAND <br /> Eli 0606 Rtv I/99 <br />