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c C- <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MASE COPIES FOR FILE <br /> LAND USE REPORT APP# P/4 - U a / H <br /> EIID RECEIVED APP.REFERRAL: - -OZ COMPLETE & SUBMIT BY /7S/3� - ale yU'Z <br /> DATE I / DATE <br /> ATTN: I-< i M[est' 1 �1 (^l/n J�l Z' (-e <br /> SITE ADDRESS: I o � 0 ,-7 S �)" // P Q JA/kms` <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 /> 3 - - <br /> aL <br /> I recommend: Appr al Denial -WWOKI "Insp s Signatur <br /> Supervisor/Lead Senior Comments: <br /> } Q SAW on l.2-► 9- 1177 <br /> 4411� E 6 a <br /> on-- <br /> - S <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA J/CHECK OFF L/ST: _Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 _Correct CONDITION(S)? _Logged is LAND USE ROOK? <br />