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IIIL <br /> NOTE: PULL ALL PERN4,-S (SEPTIC, WELL, ETC...) N,-AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> END RECEIVED APP.REFERRAL: 11 0'L COMPLETE & SUBMIT BY t a ' I3 - a <br /> DA E DATE <br /> ATTN: 2_C ) cr n 2S <br /> SITE ADDRESS: Lloas (AJ a" f2iinapl-. 1 <br /> In completing the Land Use investigation, draw all Public ealth 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 /> =f- /k/ 4& &,Z d 12- <br /> d2, <br /> zdL /G✓ cS�7� ��n 1 <br /> yI rES o��ra4� �//I�w.uJ�rl <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> • o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> _ OA if CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />