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Tl <br /> /NOTE. ,�FULL ALL PERMS (SEPTIC, WELL, ETC...) E KE COPIES FOR FILE <br /> LAND USE REPORT APP# SCJ <br /> EIID RECEIVED A1111.REFERRAL: 12—91 COMPLETE & SUBMIT BY 1 C2 —O a <br /> DATE `` f DATE <br /> V <br /> ATTN: +'� Jail <br /> l <br /> SITE ADDRESS: j J cv,n d <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 O COMMENTS: <br /> �v vz ' <br /> r <br /> 2 <br /> v c�ti <br /> h tJ2 4 <br /> JV Jr � <br /> r <br /> I recommend: Approval Denial Continuance Inspector's Signature r <br /> Supervisor/Lead Senior Comments: <br /> 1114 <br /> 4 <br /> C 510 ,. ,, ..►� <br /> C, « 0-3 (/ <br /> IS :O / <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA I1 CHECK OFF LIST. - Proofread report?x Correct LAND.USE#9 d"".7. <br /> ` ' y � ' Fr� Correct CONDITION{S) z Logged in LAND USE BODKP k <br /> Eli 06 06 Rev 1199v ,. ,r, g,�: a <br /> { <br />