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NOTE: PULL ALL PERM't�-S {SEPTIC, WELL, ETC...} NSE COPIES`FOR FILE <br /> LAND USE REPORT APP# P14 - c3 a-- - 30 <br /> EHD RECEIN''ED APP.REFERRAL:7`/ o d COMPLETE & SUBMIT BY ( - 0 ,2 <br /> DAVE {{ DATE <br /> V <br /> ATTN: Q r1r1!I� J(J 11n-1 _ <br /> SITE ADDRESS: _V7100 �. <br /> In completing the Land Use investigation, draw all Public Health factors on the ddibit (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, locatin of house, wind direction, etc.... <br /> Public water: / ItA Public sewage: <br /> SUMMARY OR COMMENTS: <br /> L <br /> �10 � <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *3e�kiriricicicacisic****************it*4e9exxie*:ck�c�FdroFk*F*****aE*k3c�c*3c**'c**vc**�rx�eiexie*xirxd�rx�c***ic�c�c�e�tir�ex�e* <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> . 0 Z&. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> QA TT CHECK QFF LIST ;l'roafre�id report7,: - Correct LAND USE#r <br /> Lagged in LAND USE B04? <br /> EH 06 06 Rev 1199 <br /> 3° � e= f Gorrec�CQNDITION{S)9 <br />