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Jy <br /> OTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# L oo a_3 <br /> EtiDRECEIVED APP.REFERRAL: Y—/I'O( COMPLETE & SUBMIT BY_/7�'S�" <br /> DATE DATE <br /> ATTN: A <br /> SITE ADDRESS: vo , cl �`* r <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: se ge disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed reap 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: <br /> 4 <br /> ... tU,-- <br /> EH 06 06 Rev 11999 ` orrect <br />