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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> w <br /> r - <br /> LAND USE REPORT APP# 1_�1 - q9 - 3 ? _ <br /> T /3 e,Art <br /> EHD RECEIVED APP.REFERRAL. _ `7- qq COMPLETE & SUBMIT BY <br /> t" DATE DATE <br /> AT.TN• _ Jim L&rl 15Ur .('1 <br /> SITE ADDRESS: � Lr <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 /> f Public water: SArA— Public sewage: '. lid. <br /> SUMMARk'--OR COMMENTS: <br /> dS4,Ida r r iF T1 C.-A C-46'—E n t-,et,E <br /> w Arn, S-rC-es ,6G , pCA-EA si <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> It ai a':irkaF ae aY ak aY ae�Ir aY a9r ati aF air�r**aY ar ale a4 aY aY ak it*ak kie aF air ac aY aY**aY is aY ae eF de ae kic ire�e*aF fe ae***aY ar ie it**ie ak ie�'e.'edt:F*aY de ae aF aF�eka'c it ie aF aF ie�e�Rr ak dt�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OAR CHECK OFFLIST.- ' Proofread report? Correct LA1VD USE#9 ,R: . <br /> eta 06 06 trey IMCorreef COIYDITION(S)'. LL2`Lagged,(n LAND USE.BOOK? - <br />