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'° <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) AA$E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> END RECEIVED APP.REFERRAL: I r��'OZ COMPLETE & SUBMIT BY it 17� <br /> DATE DATE <br /> ATTN: i-eF nne Mueller <br /> SITE ADDRESS: a 0 3 S 0 !I Il P a n e &4 Ce,ma 7 <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 /> a sewa �— <br /> Public water: �� Public g <br /> SUMMARY OR COMMENTS: <br /> rlw ! ." 04 v Thi C � _� ' , l ✓ c��h,�,/js�{ <br /> z J> <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> r o 7 ;e s <br /> ff ERVISOR/LEAD SENIOR APPROVAL: <br /> Yron rend report? Cnrrecr LAND USF.H? <br /> Q�H CHECK OF Copse t CONDITION(S)'f ._.__.L��ara �" L^rvr� rise nooxa <br /> _, u99 <br />