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P ,�r� L <br /> M-54E: PULL ALL PERMI S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#_ L A -,0 b- :2 3 <br /> EIID RECEIVED APP.REFERRAL: ( � U COMPLETE & SUBMIT BY 10 — h —O Q <br /> DATE DATE <br /> ATTN: :} n a I A41 AD <br /> SITE ADDRESS: 15 0 5 ; �Q �l y . , y�i Drr►-� <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 A/Denial Continuance Inspector's Signatn <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> "OA IT CHECK Q,�F LIST �' s...;:Proafredd report? 9 ;M�. �`Corect LAND USE#9 ; <br /> EH 06 06 Rev ll99 � �t ` ' Correct CDIVDITION{Sj.� Lagged in LAND(ISE BOOK? - <br /> y <br />