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NOTE PULL ALL PEW,,TS (SEPTIC, WELL, ETC...) .,EKE COPIES FOR FILE <br /> LAND USE REPORT APP#�A-�a - lbs (rnSL_ <br /> EFID RECEIVED APP.REFERRAL: _d a "CSL COMPLETE & SUBMIT BY — I ( 'n a <br /> DATE DATE <br /> ATTN: l 5 e 'R k)(O i G4 neje 5 <br /> SITE ADDRESS: a �Q�p �VJ l' R\ <br /> 5 a C ,O, (Vjp ') <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> ater 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 /> a' 4 Cleatf oKf Q- - �0 'i�m�� /��A/,1-7 AL,,, <br /> C ' <br /> I recmnYaatid- Ap roval Denial Continuance Inspector's Signature <br /> xx*�**x�x�***x:� ;�xx*xx*�xxxx***xx*Kx��xx*xxxxx�xxKKxxxxx*x; xxxx***x*x:�**xxxxxx*xxxx*xx*Kx,� <br /> Supervisor/Leadenior Comments: <br /> a > /ld+ <br /> C-1 4o <br /> -,t y�wa2a0/Q b-4� d .o� �. iC".L� <br /> p <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST: _Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1 i':) Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />