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NOTE: PULL ALL PERNftS (SEPTIC, WELL, ETC-) Ni<KE COPIES FOR FILE <br /> LAND USE REPORT APP# p�-off <br /> £HD RECEIVED APP.REFERRAL: / CoOZ COMPLETE & SUBMIT BY <br /> 6AA DATE <br /> ATTN: (A-g_ <br /> SITE ADDRESS: oLO,3 5 1� . P_o fi P RA <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: y <br /> coy <br /> U OL �-►-e S <br /> SUPERVISOR/LEAD SENIOR APPROVAL: E9 <br /> OA II CHECK OFF LIST: :' Proofread report? Correct LAND USE#? <br /> Iii 106 06 Rev 1/91) <br /> Correct CONDITION(S)_? Logged in LAND USE BOOK? <br />