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NOTE: PULL ALL PERMITS7(SEPTIC, WELL, ETC...) N17TXE COPIES FOR FILE <br /> LAND USE REPORT APP4 <br /> L � � (� <br /> E11D RECEIVED APP.REFERRAL: G' COMPLETE & SUBMIT B Y '/�3 14 1 <br /> DATE DATE <br /> ATTN: _ Gf v7 F C <br /> SITE ADDRESS: rCd /4 CA,13�s- <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> kickkkkkkkkk*kkkkkkkkkkk icickkkkickkkkkkkkkkkkkirkkickkkickkkkkkkkickkkkkkkkkkkkkkkkkkkkkkkkk*kick <br /> Supervisor/Lead Senior Comments: <br /> r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE V <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />