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, <br /> .. ,,. <br /> V" <br /> NOTE: PULL ALL PERM,,-YS (SEPTIC, WELL, ETC...) r� AKE COPIES FOR FILE <br /> LAND USE REPORT APP# -a <br /> EFID RECEIVED APP.REFERRAL: -1S"of COMPLETE & SUBMIT BY * SF} <br /> DAT:JE=. o'! -C7 r..� <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: ? Lv ckp rd L d cice- <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 <br /> � �� � F���,� Public sewage:�,� <br /> SUMMARY OR COMMENTS: <br /> ,C} l <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> '0A'1 <br /> I CHECK OPFLftT �. ProaJrearf'report?t'' # : Correct LAND USE,lR� <br /> € <br /> E 1106 06 Rev 1/99 Correct CONDITION{S)P' Logged in LAND USE BOOK? $fF <br />