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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP-4 <br /> QQ SEHD RECEIVED APP.REFERRAL: v COMPLETE& SUBMIT BY 4SIJ 1 , el- <br /> DATE f <br /> DAT ,� ) f DATE <br /> ATTN: I !r1 A fN�.f 10 <br /> SITE ADDRESS: 1 a �1.� >� . 66th--L-Ade � <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 /> y ub <br /> I recommend: Approvaly Denial Continuance Inspector's Signa re &1' <br /> Supervisor/Lead Senior Comments: <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA,11 CHECK O�'F LIST: Proofread report? Correct LAND USE#?':; <br /> Ell 06 06 Rev 1199 <br /> 1/ Correct CONDITIONM?'Fogged in LAND USE BOOK?. <br />