Laserfiche WebLink
IZ <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) b-EKE COPIES FOR FILE <br /> LAND USE REPORT APP# -D/ `IV <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY PK — y <br /> DATE 15ATE <br /> ATTN: <br /> SITE ADDRESS: <br /> In completing the Land Useinvestigation, 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: L .O <br /> SUMMARY OR COMMENTS: 'a r <br /> C <br /> i <br /> -r l <br /> - G <br /> i <br /> I recommend: Approval PrDenial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 4S a C <br /> r4 - <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST Proofread report?�� Correct LAND[!SE#9'� <br /> x' t Y Correct CONDITION{S) Logged Fn LAND USE BOOK? <br /> Ell 06 06 Rev 1199 d,,� gs.` a: ,, a,� <br />