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NOTE: PULL ALL PERM`IS (SEPTIC, WELL, ETC...) Mr.*-KE COPIES FOR FILE <br /> LAND USE REPORT APP# .54 -OCA -� <br /> EHfD RECEIVED APP.REFERRAL: S4 -60 - COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: (} , u o /►V l'l <br /> SITE ADDRESS: -7001 IC d, 4.-2CL 6 <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: 'A2 Q Public sewage: )vy <br /> SUMMARY OR COMMENTS: <br /> ' oy <br /> OKP/621P 15-.101 <br /> a 0 <br /> I recommend: Approval Denial Continuance Inspector's Signature's <br /> Supervisor/Lead Senior Comments: <br /> t� L� <br /> a • i <br /> 64 <br /> V. <br /> } <br /> ♦ \ <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> 4 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />