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M`EKE COPIES FOR FILE ; <br /> N6TE: PULL ALL PERMETC....)(SEPTIC, WELL, .) <br /> � Pre <br /> • APP# <br /> LAND USE REPORT Y 31 <br /> v <br /> ESD RECEIVED APP.REFERRAL- <br /> COMPLETE & SUBMIT B ATE <br /> ATTN: <br /> i <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public He lth factors the 'ibrawpimple: sewage rn p o lapo sal, <br /> water supplies, etc...). Where necessary, on an attached piece o p paper, <br /> showing population density, location of house, wind direction, etc.... <br /> Public sewage: <br /> Public water: <br /> SUMMARY OR COMMENTS: <br /> ol <br /> t <br /> ` Denial Ins ector's n re <br /> I royal Continuance P <br /> I recommend: App <br /> �9e dr 4e�r�c ickkdc de�e�c�t�r 9ck��dc,F%da ie ix of irxic�e kie ie�c 3r�e ie ie�r do it ye is*F k F ak�c is 4e nF�e aF�e ie;rx�ckit�r ft�e 4e 9t�e�F 9e�c*4e$4c'4e ar daxv4 iex e�'r,Fxir x <br /> upervisor/Lead Senior Comments: <br /> r � <br /> in <br /> / a <br /> a <br /> ao. p <br /> a� <br /> SUPERVISO EUAD SENIOR APPROVAL: <br /> . Carred <br /> V Pruo read ort ; <br /> OA 11 CHECK©FF LIST `b f eP <br /> i Correct CONDI b.N <br /> L <br /> dirt D USE ODK <br /> r. <br /> 1-I10606K 1l99 <br />