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ss <br /> NOTE: PULL ALL PERM-erS (SEPTIC, WELL, ETC...), ..AKE COPIES FOR FILE <br /> LAND USE REPORT APP# Lk to- 0 ( -r)y <br /> EHD RECEIVED APP.REFERRAL: ;� -10 -0COMPLETE & SUBMIT BY —;Z <br /> DATE DATE <br /> ATTN: t + ^,r-11-7 ll <br /> SITE ADDRESS: L4C4 '�car� P6+..SS <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 /> Qoz;JFK <br /> I recommend: Approval Denial Continuance Inspector's Signature JiG-�t c <br /> vir 9r*x*�c it*9c 9r is�'c�r de 4c iiia�c do is�+c*�E�r is**fie ie�c*ie 9e�r�r*4e 9r��c pie ie�c sic�'e 9r��e�E*e+r�c**oE�e�F�c*�Ic�4 ie ie sir*�c*ic ix 9c 9c i�4e ie*�F do ie*ie�e�i is 9r*9e de�+e 9t ie <br /> Supervisor/Lead Senior !Comments: <br /> V - <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />