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i NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> is <br /> LAND VSE REPORT APP# <br /> Qe o4�re <br /> £sD RECEIVED APP.REFERRAL. <br /> COMPLETE & SUBMIT BY�q=. V -S-a o <br /> DATE DATE <br /> r <br /> ATTN: T-f n <br /> SITE ADDRESS: 39 lot'L 6=-gA eQL-, <br /> In completing the Land Use investigation, draw all Public ealth 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 /> 1. <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval �enial Continuance Inspector's Sig to <br /> Supervisor/Lead Senior Comments: <br /> Co <br /> r <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA`II CHECK dFFLIST � Prnafreird report? Gorreci LAND USE#9 <br /> p a` � Gai reef 'O.NDIT70"V00 `° ' Logged n 14 16 USE SOFT' <br /> EH 05 06 Rev 1199 ffil , <br /> �rw•"�°.`Y, y. b3_`'.h 'ha€3'`�. � ..w,,neNisX.., t'A .�". <br />