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r <br /> f WN TE. L`ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> n <br /> { y LAND USE REPORT APP# qq <br /> t EI-ID RECEIVED APP.REFERRAL: <br /> a ~�s g COMPLETE & SUBMIT BY 17-j q ` <br /> DATE // DATE <br /> ATTN: <br /> SITE ADDRESS: 1 -3 2.,3 IJ S` .�2 ' d ,) -- <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 /> IV2 <br /> 15- <br /> �� 1p l�-OZ <br /> ✓� 22-D 2 <br /> �- 22-ot4- <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> Off`.II CHECK OFF DIST:. Proofread,report? Correct LAND USE#?... <br /> EH 46 06 Rev t/99 d Correct CONDITIONS)P "-Lagged in LAND USEBOOK?., <br /> A <br />