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_ Ln� <br /> NOTE: PULL ALL PERN--rfS (SEPTIC, WELL, ETC...) N.AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> AN� . <br /> EnD RECEIVED APP.REFERRAL:DAV 13/03 COMPLETE & SUBMIT BY )j �U ``�i./D? <br /> ATTN: <br /> SITE ADDRESS: a�2 aO S Y\� C 1,e t't-e , - <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: --),z-) Public sewage: azo. <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Sign <br /> a**x:v��,v����xx***�x�+**xx*v��:�xx+*xxx�**xxt�**�*�:v������x�*���xx+*x��x:v��xx• •xx�xrnt� **:vx*�� <br /> Supervisor/Lead Senior Comments: <br /> ,rte C�v+i�+� A.s►•� /i_-cvt -�-- <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA I!CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> E H 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />