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NOTE: PULL Al-,L P:FRMITS (SEPTIC, WELL, ETC—) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> MID RECEIVED APP.REFERRAL: COMPLETE SSL SUBMIT BY 5 Q rO� <br /> DATE DATE <br /> ATTN: S lI G�rel <br /> SITE ADDRESS: IV205 <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: __.�r Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 1-0 <br /> .Z2 totz <br /> I recommend: Approval Denial Continuance Inspector's Signature T- /M�AZC <br /> Supervisor/Lead Senior Comments: <br /> ID �r <br /> C� cu� <br /> �. " a `/ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DA II.CHECK OTFLIST Pr`oofrend report?, a• {%Correct LAND USE#? <br /> _'- Carreet CONDITIONS) Logged fn LAND USE BOOK? "'. <br /> Ef�!06 06 Rev U99 <br /> :..:r'.` <br /> a§ <br />