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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) A47<KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> _ Tt , <br /> 10-1,3169P- COMPLETE & SUBMIT <br /> E}ID RECEIVED APP.REFERRAL: l I Qz <br /> DAT pp DATE <br /> ATTN: <br /> SITE ADDRESS: t <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 recommend: Approval Denial Continuance Inspector's Signature <br /> *K�'e�t�F***srkiele**fir*-1raFia:Fac*vEdeF4eair�e*FJe�c*�e**dc�e�e�ekde�e**9c**vc*>t�t�e 'exk*xYx�e�e is is ievcdc*9e$rkiexx*irir**icicvc*�eiteF*�'e�eF <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> SOA Il'3CHECK,OFFMST Proofre4d report? `Correct LAND USE# <br /> t �Garrett CONDITI0IY(SJ Lvgged In LAND USE'BOOIX�, <br /> lad 06 06 Rev 1199 f '° <br />