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NOTE: PULL ALL PERMITS (SEPTIC,) WELL, ETC...) 1VIZE COPIES FOR FILE <br /> LAND USE REPORT APP# L6 35 <br />? EHE RECEIVED APP.REFERRAL: 6 -5- COMPLETE & SUBMIT BY S ! al <br /> DATE DATE <br /> ATTN• — � <br /> SITE ADDRESS: <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 />{ <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> � o <br /> I recommend: Approval Denial Continuance Inspector's Sign t e �. <br /> Supervisor/Lea jd Senior Comments: <br /> r <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> SOA II CHECK OFF LIST rQa/read reRott? Cor ed LAND USE#? <br /> r` � rCotrct f'f)1Y�?ITON{SJ? �,Eoggetl fn`LAND iISEBOO �„ <br /> EH 0606 Rev 1199 <br /> i <br />