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NOTE: PULL ALL PERIV.'S (SEPTIC, WELL, ETC...) 1 <br /> ,.00w, E COPIES FOR FILE <br /> LAND USE REPORT APPH -—0/— <br /> Sp //7y <br /> BID RECEIVED APP.REFERRAL:— >j COMPLETE & SUBMIT BY 0 /h ✓vl <br /> DATE DATE <br /> ATTN: LPGnrJ f/(�e/lOr <br /> SITE ADDRESS: q7y q IV ,4 rI T.I v ke.n % ' Ar -7 <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: T 1 V S1�T�W� Public sewage: �j�T/ <br /> SUMMARY OR COMMENTS: <br /> r �y <br /> R) /J, p vl 2e o� <br /> I <br /> '5414, <br /> �b w s —a oh 5 S <br /> ---------------------------- <br /> • <br /> I recommend: Approval ! Denial Continuance Inspector's Signature G <br /> Supervisor/Lead Senior Comments: © <br /> 4. <br /> 0. <br /> -46 <br /> VV r <br /> o <br /> 11 gs 1'�J <br /> SUPERVISORIL ENIOR APPROVAL:Ij I <br /> • OA II CHECK OFF LIST: _Proofread report? Correct LAND USE N? <br /> SEH6 Rev I � D Correct CONDITION(S)? Logged in LAND USE BOOK? <br />