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I-AA <br /> NOTE: PULL ALL PERM*rS (SEPTIC, WELL, ETC...) Nt>tKE COPIES FOR FILE <br /> LAND USE REPORT APP# e/4 - D 3 - ,� -A LA�_ <br /> EHD RECEIVED APP.REFERRAL: Q1q1 a3 COMPLETE & SUBMIT BY 69//9/0 3 <br /> D4E DATL <br /> ATTN: 12-( & <br /> SITE ADDRESS: Q9DQ ,5 4,en (y rC4CfW)nh -1-ori <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: /y Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's S n r <br /> ��***�**����*t<�*�***�ts�i<:�s��,���r•�a�,�*�*�,�*****,���.x��**�,s��,��:��x�:���*xx*r� ��>E*�** ,�,�x�x«,�* <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? _Correct LAND USE#? <br /> Eli 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />