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a NOTE: PULL ALL PEk1VIITS (SEPTIC, WELL, ETC...)"IgAKE COPIES FOR FILE <br /> LAND USE REPORT APP#_ LA .- qq <br /> EHDRECEIVED.APP.REFERRAL: i0" y- 9q COMPLETE & SUBMIT By� — 6 �. 9 <br /> DATE / DATE - — <br /> ATTN• ;rn {rGn 11 re a (_ a 37 <br /> SITE ADDRESS: �, nl /�Q� <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 /> 4 ' <br /> Z7 ' v3 Zz 10„4 ... _._n brey7.L� 41 <br /> f�Uz , G �f <br /> oe <br /> a� � z <br /> 15- <br /> 102.5-102. <br /> I recommend: Approval �~Denial Continuance Inspector's Sign k.e _ <br /> Supervisor/Lead Senior Comments: <br /> S PERVISOR/LEAD SENIOR APPROVAL: <br /> OA:11,CHECK OF LIST. roojrend report?. _LCorrect LAND.U.SE#? <br /> FH 06 06 Rev v99 '' Correct CONDITION(S)'? "Logged in LAND USE SOON? <br />