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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NSE COPIES FOR FILE tel' <br /> -LAND USE REPORT APP# J/0 <br /> r <br /> EHD RECEIVED APP.REFERRAL: 7 Do COMPLETE & SUBMIT BY � " a - 00 <br /> DATE J I DATE <br /> ATTN• <br /> SITE ADDRESS: d DU r; �P.l d� t �� . 11Cii �0 <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 /> X22 C�� <br /> I recommend: Approval Denial Continuance Inspector's SignaturAtdW <br /> irxi�xic�rxxicz icxxicxx****ic�r �c it�k aF*x**fir 9c 4c�cx rr�F�c is is*ac icx�r�cx�r x�c�cxx*ic is�Fx�r�e�F*>'c icx3c�F is�c�ic�tle �F�t 71t 7k s'c is icx it de <br /> Supervisor/Lead Senior Comments: <br /> r <br /> �1 ;off - <br /> /0 o <br /> p. /l6 6 9 <br /> E . ;o3 <br /> ec��u�..�.C.-ip �..vK-ate _�:ut. �ca�- % a�..�n t��t- �'✓�l� ��o� <br /> C)(o <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFFLIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged w LAND USE BOOK? <br />