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RMIS SEPTIC WELL, ETC...) MAKE COPIES FOR FILE <br /> NOTE: PULL ALL PE <br /> LAND USE REPORT APP# L t4 _01 y _ <br /> COMPLETE & SUBMIT ` J P <br /> EHd RECEIVED AT!'.REFERRAL:6 �—D COMIT B �"� <br /> DATE DATE <br /> Q- <br /> ATTN: Q. C� v 61 <br /> SITE ADDRESS: a 3 J 4 ' <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 O COM ENTS: <br /> C <br /> r � <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> Seas*it <br /> OA111 G'HECK QFF LIST Praafreud reppr�f? co -,rreat L;4 ND USE# <br /> x �r <br /> E13 Q6 Q6 Rev 1199 k�wwq Carred ONDI71©N(S) ogged4h L 'D USE BOO.K7 <br />