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NOTE: PULL ALL PERMrfS (SEPTIC, WELL, ETC...) MriKE COPIES/F/�OR FILE <br /> -/1/104410�7-j <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL:--7- <br /> EFERRAL: f - COMPLETE & SUBMIT BY ---7 l-'1` AS4P <br /> DATE I � DATE <br /> ATTN: �lsn(JI(/ ��{I/l�{f®•f/Ir <br /> SITE ADDRESS: 1 Ce Ai-" M ' * <br /> T <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 /> 62 t-Vl> 7 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 0 /e <br /> e4 l/ Y ► + ` <br /> 7 3r '? . at <br /> f�) <br /> 8. <br /> ow <br /> 4V V <br /> C <br /> aS <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> U�11�eF�'ECIC[lFE ELIST �� Proafrear�report � `�CorreciLAND rISE9 <br /> EH 06 06 Rev V49 <br /> Cnrrect C©NDI7TON(S}P �4Logged rra LAND USE BOOR? <br /> ria` <br />