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f <br /> NOTE: PULL ALL PERM 'S (SEPTIC, WELL, ETC...) 1E COPIES FOR FILE <br /> LAND USE REPORT APP# f2� -� /_ _I(�� _ <br /> 0 <br /> EHD RECEIVED APP.REFERRAL: 0-0 A COMPLETE & SUBMIT BY r <br /> DATE �� DATE ` <br /> ATTN: <br /> SITE ADDRESS: oo ry� ck , l <br /> In completing the Land Use investigation, draw all Public 6ealth 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: _ 4n <br /> SUMMARY OR COMMENTS: <br /> i <br /> I <br /> i <br /> I recommend: Approval 'Denial Continuance Inspector's Signa <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> 45 <br /> IV <br /> .� <br /> o`u— <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA'II CIECK Q1�`F LIST, >Proafread report?. P` Correct LA <br /> USE;# <br /> 1106 06 Rev 1/99 & CorreclCONDITION(S). ". Logged in LAND ITSEBOOl�7 ,� <br /> 7 ,. - <br />