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In <br /> NOTE: PULL ALL PERMVrS (SEPTIC, WELL, ETC...) iv,-AKE COPIES FOR FILE <br /> LAND USE REPORT APP# 03 -/73 <br /> -Z EHD RECEIVED APP.REFERRAL: _+ Q) COMPLETE & SUBMIT BY Aq A o <br /> ATTN: CJVA f'1 �� r �l <br /> SITE ADDRESS: -7 S �� rS <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 /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> icia9c$c�e�kxkahx$e9r�e>c�F9t�c9t�t9r�sdc�kir�cic�c�riE3c:FaE�'eic�Fdrk�Fkjck�FknF$��cie�r*irk�Fk3e$:��cat4txir�cdedt9c9e9cdreF9c�c:EaE�k�c$cka�icir�Ficvcicir�cick$c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST F Proafrerrd reparl� �Carrm LAND USE#9 <br /> Eu 06 06 Rev 1/99 �' � C �orrect GbNDITI0IV(S)? � :` Logged in LAND USE BOOK?�,,,' �. <br />