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NOTE: PULL ALL PERMi<-.,,S (SEPTIC, WELL, ETC...) N,_. KE COPIES YOR FILE <br /> r LAND;USE REPORT APP# <br /> F J—r) Ok COMPLETE & SUBMIT BY <br /> E13D RECEIVED APP.REFERRAL: � <br /> DATE DATE <br /> i ATTN: it <br /> SITE ADDRESS: _ `� � `�� d�cr`Q L A , c-L4nn - <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 /> s <br /> t <br /> f <br /> e <br /> ... <br /> I recommend: Approval Denial Continuance Inspector's Signatu <br /> Supervisor/Lead Senior Comments: <br /> TAP <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> tlA',II CHECK OFFLI. � ,e Proofreadrepo Correcl LAND 11SE# ; <br /> . <br /> EH 06 06 Rev U99 ` arrest IV(S) Lagged'in:LAND USE BQOK?} <br />