Laserfiche WebLink
NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 11AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> ( <br /> EHD RECEIVED APP.REFERRAL: -,l/�- 1p 9 COMPLETE & SUBMIT BY <br /> DATE // DATE <br /> ATTN: 'lk P4 n e <br /> SITE ADDRESS: 100 9 S 5. /drr �/i1�, �d• i�nrli �ir ,o <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 /> `d <br /> I recommend: Approval ,✓ Denial Continuance Inspector's Signature <br /> Supervisor/LeadrSenior Comments: <br /> f� 11 : 07 <br /> D 3 <br /> o�� o <br /> SUPERVISOR/LEAD SENIO APPROVAL: c� <br /> OA !I CHECK OFF LIST.• _j�Proojread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />