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NOTE: PULL ALL PERMi-,9S (SEPTIC, WELL, ETC...) M,--,KE COPIES FOR FILE <br /> LAND USE REPORT APP# J- 14 <br /> V-e <br /> ED RECEIVED APP.REFERRAL: '�`OF / COMPLETE & SUBMIT BY� _�d� <br /> DATE DATE <br /> ATTN: La xlexe (1 U <br /> SITE ADDRESS: vo P/X fforc e (1,011T) j "n <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 /> I <br /> SUMMARY OR COMMENTS: <br /> �f <br /> (o <br /> EI <br /> :h <br /> Ei <br /> a MR-P W tTt-t r.'ge M6-r <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 6 <br /> E< <br /> e <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> EI <br /> E< OA II CHECK d LIST � Proojregq report Correct LA1VD'USE#? <br /> EH o605 Rev 1199 � � Correct CU 'DITTOIY(S}9 Logged fn L'�9ND.iISEBQOIC� - <br /> t-.; d' ':.ucx:u�a.e.,. <.. •`.et:Win- .i?ti> <z-. .saa�- r.: ,' k:.�,'?;rr.,, ;s `2 <br /> s- <br /> Ek <br />