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NOTE: PULL ALL PERI_ 'S (SEPTIC, WELL, ETC...) IRKE COPIES FOR FILE <br /> LAND USE REPORT APP# L 14 YC `6 t <br /> AQ <br /> — ti <br /> �`I a <br /> MID RECEIVED APP.REFERRAL: '�3 -CJI COMPLETE & SUBMIA a �', 30 . <br /> 6-A-TE DATE <br /> ATTN: (1A Ce <br /> SITE ADDRESS: -P ,1 k'" <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: / 7r <br /> SUMMARY OR COMMENTS: <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Sign t <br /> Supervisor/Lead Senior Comments: <br /> V V <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA'IICHECK OFFLIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />