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7-V <br /> ' ,,OTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...)MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: <br /> 3 - a7--61 COMPLETE & SUBMIT BY —17 7`0 j <br /> DATE DATE <br /> ATTN: Le <br /> SITE ADDRESS: _ �' 3�1 1d { , r2 c' w'k �o ru ,r-9 <br /> In ornpleting the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: sewage disposal, <br /> ater supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house,wild direction, etc.... <br /> Public water: G C it ublic sewage: <br /> SU MARY OR COMMENTS: <br /> 1' <br /> / , <br /> � r <br /> ti I recommend: Approval Denial Continuance Inspector's Signature . <br /> T de 3c 9tir�k�'e�e�&�e�c9e9edt9r:Vrnie9r9cir�c:ESE:E9e�r�eiealex�4�e9ckir�e$e9e$ex�Y�rdeaE9e�Feek�eieieieit3r�ic*�cir*dc$cir�ex�eirieicaEk$c�F9e�'ekaF�kie�F�k�ririe�eit*x� itic�c <br /> f <br /> Supervisor/Lead Senior Comments: <br /> SORILEAD SENIOR APPROVAL: <br /> U <br /> ¢ ,.OA'H,,CHECK OFiFLIST A .{Proofread report? $ya Correct LAND C15E#' <br /> 99 ` <br /> ' COrreet GONDITION(S}9 LOgged rn LAND USE B04K? r <br />