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y TNOTE:VULL ALL PERK S (SEPTIC, WELL, ETC...) T KE COPIES FOR FILE <br /> LAND USE REPORT APP# t2X -q V-.z CREviSIO S <br /> EHD RECEIVED APP.REFERRAL: /ol -01_ COMPLETE & SUBMIT BY— � <br /> DATE DATE <br /> ATTN: _ JENN1-1a,- jo4-L y elf <br /> SITE ADDRESS: 1 F. A NbT <br /> r <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 /> AAV • 4 <br /> r <br /> 7, <br /> I recommend: Approval Denial Continuance Inspector's Signatures <br /> Supervisor/Lead Senior Comments: <br /> d <br /> f <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> "��)�II GHECJ�C OFA'LIST�� ``%Proofread report?� � Eorrect LAND:USE#9 �; <br /> GH 06 06 Rev 1/99 <br /> '`` �"Carrect CDNDITIDN{S)7 " w+ Logged rn I AND USE BUOK7 ' <br />