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�m <br /> NOTE: PULL ALL PERS[S (SEPTIC, WELL, ETC...) N,.,KE COPIES FOR FILE <br /> LAND USE REPORT APP# 0 c -S3c/C,r�s) <br /> EFIDRECEIVEDAPP.REFERRAL:101010Z COMPLETE & SUBMIT BY <br /> DA n nom_ DATE <br /> ATTN: -IR i r 4' <br /> SITE ADDRESS:I I (7 S f)— v ry A. L)cn <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: ,,-,-2� Public sewage: /azo <br /> SUMMARY OR COMMENTS: <br /> �'•t"'7- <br /> ��• �' 1Fr�TJN_C//i'/ CT>+I t.,,/al �/ � <br /> I recommend: Approvaly Denial Continuance Inspector's Sig t � r <br /> Supervisor/Lead Senior Comments: <br /> oY <br /> : o / <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFFLIST.• Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/9e Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />