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LIrI <br /> NOTE: PULL ALL PERAWTS (SEPTIC, WELL, ETC...) N AKE COPIES FOR FILE <br /> LAND USE REPORT-- ''���� APP#S// - 61 - C/1I <br /> �� <br /> EIID RECEIVED APP.REFERRAL: 5— COMPLETE & SUBMIT BY (� - 5-01 <br /> DATE - DATE <br /> ATTN: Jenne '� eq <br /> SITE ADDRESS: 113-J N S. -s+• A). Nn dam.•Ir_ ed. <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 /> r <br /> 17 zd2z�� <br /> 44. s <br /> I recottrtmend Approval enial #}� Continuance InsIrei Signatu <br /> Su rvisor/Lead S for CooA mments: <br /> © �. <br /> 0 �- <br /> Q <br /> F 171- D <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 5 SSG .Ce v*+,e cSa6 . <br /> D. II .03 01 JQ <br /> OA 11 CHECK OFF LIST.• Proofread rep orl? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />