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lv <br /> f i <br /> NOTE: PULL ALL PERMT S�(SEPTIC, WELL, ETC...) MX E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> E11D RECEIVED APP.REFERPOLL: `o< I / COMPLETE & SUBMIT BY ��— <br /> DATE DATE <br /> ATTN: 1 o <br /> SITE ADDRESS: ��� /" �' C� f V 9 - <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, locationjof house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> � ► ✓ G E rs. L�-�f �d- Ji! 4 z <br /> 100, <br /> .� <br /> I recommend: Approval Denial Continuance Inspector's Signatur -r-et2 �<< <br /> Supervisor/Lead Senior Comments: <br /> •Lv � � �y Wit,w / c'c_<•c f :..,,�, i�r <br /> l' c. r c rtiJ TC !c <br /> Ll 1149. 3 <br /> G <br /> 1 . \I 1J . �� a� ? •y <br /> d <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 7,77 <br /> U OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Ell oG 06 Rev 1/0 `�{rli�4 Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> lwr� f .. <br />