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NOTE: PULL ALL PERN..Y'S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# P/4 -03-dq.�/S,4 ) <br /> Ell RECEIVED APP.REFERRAL: JC b COMPLETE & SUBMIT BY 9/--20-��7.3 <br /> DATE DATE <br /> ATTN: B ( C 0, n <br /> SITE ADDRESS: I qq t�as�'S��&fg <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 /> —�/l��i�c-� ' •UD,��//r7�/�EL�x-�7�9J�"c+�7�is .5r7c�9��J1�S <br /> �1•Q9 c.� 4 � <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> �c 9c is is�c is*ir k 9c�cx*�xicx�c*c*'c 4�c a'c irxe is 5c irxXxE ie*ic�c 9c�c 9c�ac'c is is ie c icxicxxc is c�c�cxicxxic:exxic is is�c is is�e cx�c is�c iic is is ie iic�e c is is <br /> Supervisor/Lead Senior Comments: <br /> a � <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> LAND USE LOG -L� OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> ON CALENDAR Correct CONDITION(S)? Logged in LAND USE BOOK? <br />