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NOTE: PULL ALL PERM <br /> 1` S SEPTIC, WELL, ETC...) M.,KE COPIES FOR FILE <br /> LAND USE REPORT ^^ APP# P A- 03 <br /> EHD RECEIVED APP.REFERRAL: a COMPLETE & SUBMIT BY 1 a. Ig <br /> ATE <br /> DAT <br /> ATTN: I )Qsz <br /> SITE ADDRESS: a S 63 L 7 & U <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: o�, <br /> SUMMARY OR COMMENTS: �� d 3 ✓ ^ j� <br /> aa ;o/ <br /> >>ez.�K. <br /> I recommend: Approval X <br /> Denial Continuance Inspector's Signatur w <br /> Supervisor/Lead Senior Comments: <br /> Oy a aJ <br /> *49 <br /> a : o <br /> AA j <br /> SUP RVISOR/LE D SENIOR APPRO AL: <br /> � 3ect tt <br /> M.( z <br /> 9 <br /> OA/I CHECK FF L/ST: _ . Logged <br /> report?L�ed en LCorrAND USE BOOK? <br /> /t�rY`pv'eot cr�o� Correct CONDITION(S) <br /> Rev <br />