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NOTE: PULL ALL PERNtrfS (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT APP#;j,4 -00-troy XeoIseel <br /> Elm RECEIVED APP.REFERRAL: � -0 -0/ COMPLETE & SUBMIT BY - � p " Q <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: ) .1_r) D Ll /y , My n d x e-CL 4-0 ( i <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 /> Publie-water: ►�� Pe e: 6� �/ fd #6tt-so <br /> SUMMAR R COMMENTS: n 7 <br /> A/11 ZL r�� ¢_,Y 2 y t 1yy a o S ZF eo—o'�l <br /> I recommend: Approval Denial ContinuanceInspector's Signature_ <br /> Supervisor/Lead Senior Comments: <br /> � Y <br /> SUPERVISOR/LEAD SENIOR APPROVAL: - <br /> OA ri CHECK OFF LIST.• _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />