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Ic c <br /> NOTE: PULL ALL PERMtfS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APT# <br /> EHD RECEIVED APP.REFERRAL: 3-Q I-CIJ COMPLETE & SUBMIT BY .3 <br /> DATE ,,��II ," I�,W1DATE <br /> S <br /> ATTN: l� � u'U �M' C& <br /> SITE ADDRESS: ao20 L` Eac 'M'a <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�d/ens/'ty, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> l <br /> I recommend: Approva Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 07 <br /> 7" No <br /> am.d� <br /> S <br /> vlc <br /> ell <br /> vc <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 77 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rey 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />