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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MARE COPIES FOR FILE <br /> LAND USE REPORT APP# _ , - - X50�j(S�yJ <br /> EHD RECEIVED APP.REFERRAL: <br /> a6 03 COMPLETE & SUBMIT BY 1D11 5163 <br /> DATE DATE <br /> SITE ADDRESS: J y <br /> In completing the Land Use investigation, draw all Public Health factors on e 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: /l.0 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> D <br /> �1/rL O/ /`"'d' 9tts�� �A� ��.✓r'T� /C�""Lae-c <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature / •< <br /> Supervisor/Lead Senior Comments: <br /> Oq <br /> l I� 0. /Mot�rw�t3- <br /> w <br /> r • 0`�.i <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST., Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br /> EI 106 06 Rcv 1/91) <br />