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MOTE: PULL ALL PERNk..,'S (SEPTIC, WELL, ETC...) N EKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EED)RECEIVED APP.REFERRAL: /-/0 -oO COMPLETE & SUBMIT BY o2 - / - 0O <br /> DATE DATE <br /> ATTN• Q F 6-. Sher <br /> SITE ADDRESS: 3 a Jaz r L—+OV Q (Z 1 � <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 /> � C- �S <br /> / -o6 <br /> 1 recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead `Senior Comments: <br /> No lPt��� S <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OF LIST: V Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? �Logged in LAND USE BOOK? <br />