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i f <br /> NOTE: PUr.L ALL PERMII4 (SEPTIC, WELL, ETC...) Nig.. E COPIES FOR FILE <br /> LAND USE REPORT APP# �-v/- y3 <br /> EIID RECEIVED APP.REFERRAL: S COMPLETE & SUBMIT <br /> D E DATE <br /> ATTN: I-Ir fls <br /> SITE ADDRESS: ��P� �6 s✓ f% ze 14 <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 /> s <br /> lS�CII/ <br /> I recommend: Approval Denial Continuance Inspector's Signature /,) <br /> a "I <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> eEH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />