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Y L <br /> �% NOTE: PULL-ALL PERMI'rS (SEPTIC, WELL, ETC...) Mr,_.�CE COPIES FOR FILE <br /> LAND USE REPORT: APP# <br /> 01 <br /> EIID RECEIVED APP.REFERRAL: COMPLETE & SUBMIT B iN _ .BY- ' �' t�Z <br /> DATE DATE <br /> ATTN: — <br /> SITE ADDRESS: off,L4 a L4oLo� <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 /> E <br /> t <br /> I recommend: Approval Denial Continuance Inspector's Signature <br />{ Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> SOA IT CHECK(aF IIS Prvofrad r�eFort Got�LA'2VD USE# <br /> - . <br /> rr�ob ob Rei v99 iG'orreer GUN�IID (S} LaggetF fn G 4ND U5E SpoX[� <br /> mac*air <br />