Laserfiche WebLink
J 1�1/rn rt <br /> NOTE:1 PULL ALL PERN$fS (SEPTIC, WELL, ETC...) Nt..KE COPIES FOR FILE <br /> LAND USE REPORT rrAPPA - <br /> (7V.� 'aa�l CS/ <br /> END RECEIVED APP.REFERRAL: / COMPLETE & SUBMIT BY .3 <br /> DA � DATE <br /> ATTN: JC) hn -Fur rtr�rc�p�y <br /> SITE ADDRESS: _ 7 n �� C1 L_7d— .� ed <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: ry�l •/ 5 Public sewage: /tw <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature fir_ <br /> Supervisor/Lead Senior Comments: <br /> JJ :0S <br /> 17,' ,,f Je - <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA I/CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> eli oa 06 Rev v9v _Correct CONDIT/ON(SJ? _Logged in LAND USE BOOK? <br />