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NIQhE: -PULL ALL PERN:tITS {SEPTIC, WELL, ETC...} 1*t-AKE COPIES FOR FILE <br /> . LAND USE REPORT App#__� <br /> EHD RECEIVED APP.REFERRAL: ' r COMPLETE & SUBMIT BY, <br /> — <br /> DAT <br /> ATTIC: � .J 0t- -- <br /> SITE ADDRESS: -�-��--, ea kE I�oa_JT� <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 /> �- t-� l IL C s Ok <br /> I recommend: Approval k-' Denial Continuance Inspector's Signatu e <br /> do+k#***�e�ede*ae>c**$�e:E*ik*a'eke*****�c9elr**9c�e***irie'ede*�r:lr�r*slue****ie$dck:Fteiev******�e�c*sriririe**oF***iefrc�rRc9rk*9c** <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DA II CHECK OF ST: LX Proofread repo l?". <br /> Correct LAND"SE 4? <br /> Eli 06 06 Rev 3i9e Correct CONDITION(S)? Logbed by LAND USE BOOK-'. <br />