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•N TE: PULL ALL PERMI-i'S (SEPTIC, WELL, ETC...) N1nKE COPIES FOR FILE <br /> LAND USE REPORT APP-9 LI-- 00 �7 y <br /> ie <br /> EHD RECEIVED APP.REFERRAL: f 0- <br /> 0c) COMPLETE & SUBMIT BY ��� �� �- Z� 0 _ <br /> ATDATE 1 r / DATE <br /> TN: e 7 Q t r—TS k r <br /> SITE ADDRESS: I [ , U*_ <br /> In.. ompleting the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> 1:1. <br /> water supplies, etc...)) Where necessary, on an attached piece of plain paper, draw completed map of area <br /> 1111 <br /> showing population density, location of house, wind direction, etc.... <br /> Ill - <br /> Public water: Public sewage: <br /> S ,MMARY OR COMMENTS: <br /> �I `I <br /> II� II <br /> .r <br /> Ali N <br /> ilk iI <br /> I recommend: Apprloval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> li iN - <br /> li .I <br /> S'UPERVISOR/LEAD SENIOR APPROVAL: <br /> QA II CIiECK QFLTSTE Prooort? <br /> fread iep ,� � Carrect L4ND SSE#? <br /> Elft 06 06 Rev 1199 `Correct GONDITION(S}9��;` ; Lagged fn LANDyiISE 1000 <br />