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NOTE: PULL ALL PERPr,,,,,:S (SEPTIC, WELL, ETC...) PEKE COPIES FOR FILE <br /> (1,4 <br /> R . <br /> LAND USE REPORT APP# -SA -0 I - hf?-2, ,4j2p I C-nh <br /> END RECEIVED APP.REFERRAL: (D-J-7—DI COMPLETE & SUBMIT BY 7 — 6 -o -z_ <br /> DATEDATE <br /> ATTN: v -�O 11 k. :/ <br /> SITE ADDRESS: 10 L 5 1 E , (VI a FDL2 � f*bl✓d- ., M Lt rirrn <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> •*��***�*��**�*****��******:�:*���xx�**+,�*****,�*�x�***x****x**xKxxxxx:�x,�x�x**�*:�*; �x*,�**** <br /> Supervisor/Lead mments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA jl CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />