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• E COPIES FOR FILE�°6 <br /> NO'T'E: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MA U� <br /> i'�W�c <br /> LAND USE REPORT APr# S --� _a i <br /> E14D RECEIVED APP.REFERRAL: /0—6/ COMPLETE & SUBMIT BY <br /> l�-SAe 6-22- <br /> DATE DATE <br /> ATTN: r <br /> SITE ADDRESS: N ```� <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 /> dk <br /> 2Z;v Z <br /> 22�b1� <br /> j��SCjal�,u C7` /f� �- lJ li=`C �11vES C�Lc�55iiv Pee 27``/ �I�Vg CJtIST�N� <br /> PA r?ee 5, <br /> PoTal <br /> I recommend: Approval_ Denial Continuance Inspector's Signature <br /> wz <br /> ��**��*��*��*t�•k*���t:tie*�*�a *���r�r*��*���������r��������e�*�*������t*�*�e*�*�� � �*�t*��*�� �.., <br /> r <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> . 11 :6( <br /> • ./+M�'.�.r�CiO SIVA����"' <br /> y <br /> i <br /> SUPE ISOR/LEAD/SSE{NNIIOR APPROVAL: <br /> 6 <br /> L 1 <br /> P OA II CHECK OFF-LIST." Praofread report? Correct L.9ND USE# <br /> �' Lo ed in LA10 USE BODK? <br /> E 06 06 Rev 1/99 CQTreGi�OD�TILIIV(S'}7 �g <br /> x <br /> 47 <br />