Laserfiche WebLink
K L <br /> -NOTE: PULL ALL PERMit'S (SEPTIC, WELL, ETC...) NiAKE COPIES FOR FILE <br /> LAND USE REPORT APP# JM - 0O _ C� <br /> EHD RECEIVED APP.REFERRAL: V-I J00 COMPLETE & SUBMIT BY 0� <br /> DATE DATE <br /> rr, _ <br /> ATTN• ,� L t-� �I 5 h2 L <br /> SITE ADDRESS: L 3N 5 S "-y\, r v C� . <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 /> (a <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *9e�c�c**ic�e�k9eie*�c9ric*�c�c�e*�c�'cic9cia�cie*9c*9e�c 4ririric�c�r�cie9e9cic�cie�c�c�c�cirick�rie�ciric�crcicieirxxiricicx�'c�'c*dc ierc�c�cicx�`e*x� xdc9e�c�'c�ex <br /> Supervisor/Lead Senior Comments: <br /> ow <br /> off-� :�c�•-- <br /> D W- 03 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFf LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />