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NOTE: PULL ALL PERMIY`S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT <br /> qq Q()APP# 5/4 - Q -�/ <br /> END RECEIVED APP.REFERRAL: l, �-ll"O U COMPLETE & SUBMIT BY / d -0' <br /> DATE DATE <br /> ATTN: , m U/hivlJ P .� <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibi o.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 /> 0(2 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: g / <br /> J (0 a e�Ot dYI.O 09 �ivn7f min' r�(.� <br /> • eY�t.�'Inti I/I �l <br /> J <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 10 <br /> OA!!CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />