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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) Nin:-{E COPIES FOR FILE <br /> LAND USE REPORT APP# S fA-`PJ) �y <br /> EHD RECEIVED APP.REFERR.-U: i0-30 v I COMPLETE & SUBMIT BY 1 (— -�—Q G I — <br /> DATE �D r DATE <br /> ATTN: 3 <br /> SITE ADDRESS: IQ- <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i( 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: <f,S SA 3 / Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 2c _ <br /> I <br /> 66 <br /> Inspector's Signature_ <br /> I recommend: Approval Denial Continuance Ins p <br /> x>c icx�c icx�cxsc�c*�c�Y is�c�cx*xic�cx�F�c�c it x>c**icx icxxic*>cx>c�c***�c�'c is�cxicxic>cic>k sc�c is�cx�c�cxicx*z*�F�F:c is:cx it-ic it ycx it*x�c�F x�c acx* <br /> Supervisor/Lead Senior Comments: <br /> 01. Ic <br /> t <br /> / <br /> SUPERVISOR/LEAD SENIOR APPROVAL:-i <br /> " <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> 1-1106 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />