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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> ERD RECEIVED APP.REFERRAL. �V - COMPLETE & SUBMIT BY (� -j3-00 <br /> DATE DAT£ <br /> ATTN: Ti, o Ind rrri .r -- <br /> SITE ADDRESS: AN 14 , 4y—D ,q L),e . S 7 OCi��y►'�. -_ <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 /> CAH o <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> -600- <br /> C�t17I CHECK OFFLIST- � Pro`ofread tep � Co sect SAND iI <br /> USE a7 <br /> Ex ob os Rei i1/99 C eci CONUMON(S>g _ Logged toIND L SE BOOKS <br />