Laserfiche WebLink
NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# Afi.S -9S -/,) p 4 )k a <br /> EHD RECEIVED APP.REFERRAL: —60 COMPLETE & SUBMIT BY - ;? —Oy <br /> ATE DATE <br /> ATTN: <br /> SITE ADDRESS: J .5 SO l S . LIA-ipu In L� 1t K&L 664<�vyc v 7`,�-ti <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 /> Coil No "6.0 e0A)L)iT10"a /V'U2 20;0/ 1 �`T Cil / Sv2 �xSTirvG CowJT <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />