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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) ft*KE COPIES FOR FILE <br /> LAND USE REPORT APP#,'/4 -99-qj <br /> EHD RECEIVED.APP.REFERRAL: 10 -20 `r COMPLETE & SUBMIT BY'lq5dO /J <br /> DATE DATE <br /> ATTN• l�� , L✓UMrn <br /> SITE ADDRESS: 15 '1,5/ <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: VOW Public sewage: <br /> SUMMARY OR COMMENTS: <br /> ,p�v� sPd sed or / s s� <br /> I recommend: Approval 'Denial Continuance Inspector's Signatu4 <br /> Supervisor/Lead Senior Comments: <br /> C a�Drzoy /Izyc�,.�i� /00A 00- °zo <br /> lodi.4v�.t.�f� .UJ.�1.a.st.Q.- 2►*0.1/ �tQ.GC.. 4l ,Q�l. <br /> �`SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• _Proofread report? _Correct LAND USE#? <br /> Rev 1/99 _Correct COYDITION(S)? Logged in LAND USE BOOK? <br />