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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MrrKE COPIES FOR FILE <br /> LAND USE REPORT APPa <br /> 'p �) COMPLETE & SUBMIT BY 4 <br /> EIID RECEIVED APP.REFERRAL: � <br /> DATE �/� DATE <br /> ATTN: t 1/�� LICJ,-e ✓� <br /> SITE ADDRESS: � ' I 2t 9 /�t� ✓v�G�a t�4 ��� <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA /I CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> Ell06 06 Rev vee _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />