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NOTE: PULL ALL PERM' 'S (SEPTIC, WELL, ETC...) r .KE COPIES FOR FILE J L <br /> LAND USE REPORT APP# SA-D /- -7 <br /> END RECEIVED APP.REFERRAL: &YZ01 COMPLETE & SUBMIT BY '?//!E f n <br /> DATE DATE <br /> ATTN: JOSe 4 k 1 AA es' — <br /> SITE ADDRESS: `f�20 / /I/ Azp r,;forz Pol. S7LOCkA/1 <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 /> O <br /> TitE Y�426DtO6� rs� Ado t�Gvs i9 f✓ <br /> 10, jj�o m e c)&& o 'ufu� rjZEP i9 i 2 IgREs� <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 9'-7 n- f 3 T 19 1 <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: Ca <br /> OA II CHECK OFF LIST: —Proofread report? _Correct LAND USE#? <br /> GH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />