Laserfiche WebLink
NOTE: PULL ALL PERN-wTS (SEPTIC, WELL, ETC...) :-eAKE COPIES FOR FILE <br /> LAND USE REPORT APP# S 14 -297 —i <br /> EHD RECEIVED APP.REFERRAL: - NCOMPLETE &'' SUBMIT BY g _ 7 — <br /> DATE <br /> DATE <br /> ATTN: I O r� i�-S <br /> SITE ADDRESS: ( < < < 4 /F J <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (}.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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> OAP �i✓1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA !I CHECK OFf LIST. Proofread report? Correct LAND USE 4? <br /> EI I 16106 c <br /> a Rtv 99 L-,/Correct CONDITION(S)? Logged in LAND USE BOOK? <br />