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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) N,,-KE COPIES FOR FILE <br /> LAND USE REPORT APP# 5- 0 <br /> . A-QAP-BY" <br /> EHD RECEIVED APP.REFERRAL:J, COMPLETE & SUBMIT <br /> DATE DATE <br /> ATTN-. )')S P. RiA"A /I a - <br /> SITE ADDRESS: _a a �sc) as - �, LL 1 cd Y i- Lae <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: �-za <br /> SUMMARY OR COMMENTS: <br /> 0% - <br /> I recommend: Approval Denial Continuance Inspector's Signa r <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> DA 1l CHECK�FFLIST �:;Proojrearl report : <br /> Correct LANYD USE#9> <br /> �. CorrectCONDITIC�V(S) zagged r►r�LAND USL�BQOI � i" <br /> _ <br /> Eta pG 06 Rev 1199 w r .. Aw_, xf c <br />