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N' T.4, PULL ALL PERK 'S (SEPTIC, WELL, ETC...) : EKE COPIES FOR FILE <br /> LAND USE REPORT APP# PtQ -o <br /> BID RECEIVED APP.REFERRAL: O /3- C)-Z- COMPLETE & SUBMIT BY 4 - 3 O <br /> DATE ` DATE <br /> ATTN: _ 1�r�% -1' �010-4 <br /> QInSITE ADDRESS: -I 5.3 L� (i 'e,� )0— <br /> In <br /> 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 /> AAWev <br /> 9f <br /> pot <br /> Sell <br /> 00 <br /> ocl rof I e`ia Continuance Ins ecto nat. <br /> `� P g <br /> icxicixxic$rxr�x:'cXicicx:ccr.9cc9cxx�kieieicic�c�cic�xicicicieicieic�c�cx��c�:k4e�e4c'ck�c�cx'c�cxxxic�eicicieicicicic*� 9e�e9t 9r�exieica'cic�t�txxx <br /> Supervisor/Lead Senior Comments: <br /> Cc e <br /> j 0 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> El(06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />