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J r5I <br /> NO'T'E: PULL ALL PERMI-i-S. (SEPTIC, WELL, ETC...) MtiKE COPIES FOR FILE <br /> LAND USE REPORT APP# --00- 7 __ <br /> END RECEIVED APP,REFERRAL: — COMPLETE & SUBMIT BY /l — f( —0 0 <br /> DATE n/1 1 DATE <br /> ue <br /> er <br /> SITE ADDRESS: _1 2-gar} i 6 '�e Aa <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 /> d <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ****9th'4c9t9t9t�sk:E$s*�c**9c*�r9c 9c�cJr*xx*knF*'eJrvYx�e9r�r*Icafr�ek*ie*�e�e ie*�t�t9tX*�cdc**E**�r*�r�c*ir�t*�kir�e9e*kdeJcde*�eJcvk'c�rkEF* <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ,. <br /> DA II CHECK QFF'LIST Praojreari report ���� Gorreci L:41V1�SSE;.#7 <br /> EH 06 06 Rev 1199 '; §° k Correct CONDITTON(S) ' Lagged�n'LAND USE BOOK? <br /> ra,r s <br />