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NOTE: PULL ALL PERlk S (SEPTIC, WELL, ETC...) _ kKE COPIES FOR FILE <br /> LAND USE REPORT APP# A 0/-G _3 <br /> Y <br /> \-j(/— - LP�e�re <br /> END RECEIVED APP.REFERRAL: � V161 COMPLETE & SUBMIT BY / , AQA P <br /> � <br /> DATE DATE <br /> ATTN: ,din h br At wa //a ct, <br /> SITE ADDRESS: 3fS3iS S r),-,4-o r .P n a at - '%✓ tit <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 /> 01� <br /> f� o\ C�� ��✓t�,im.� <br /> I recommend: Approval V Denial Continuance Inspector's Signature/ <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> [OA II CHECKOFF LIST., _Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOKP <br />