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�y <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) NiriKE COPIES FOR FILE <br /> ]SAND USE REPORT APP# �, /� -C7� <br /> I <br /> ExD RECEIVED APP.REFERRAL: -,IS-C3 COMPLETE & SUBMIT BY f��? -a2 -p <br /> DATE DATE <br /> ATTN: P LA <br /> SITE ADDRESS: ' <br /> iM <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 /> I <br /> Public water: V t°5 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I <br /> .I <br /> I <br /> i <br /> I`I <br /> I <br /> II <br /> I <br /> I recommend: Approval Denial Continuance Inspector's Signature �� <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> I� <br /> I <br /> .I. <br /> N <br /> .N <br /> IN <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> SOA II CHECK Q,1�'F:LIST �s Proo read re ontP §�"��Correct LAND FTSE# , _�- <br /> Eli 06 06 Rev 1199 3 `� r � orrect C4h'DIT7Q VfS)7 L agged In LAND E Bu <br />