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Itaw <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) TWAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 3� <br /> EHD RECEIVED APP.REFERRAL: "d -0�D COMPLETE & SUBMIT BY__2 — j —OZ <br /> DATE ' DATE <br /> ATTN: P �: 4—_► ,S Y 4 — 1 <br /> SITE ADDRESS: c, , ,ro•[� 61 U d <br /> Z3oro <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 /> aye <br /> Kfmc)uE y0°s 1+ ,Nearr6 V- 45Pt #mi,-r�-2yM Srr& <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> kkkkkkiekkkkkkkkkkkkkkkkkkkkkkkkiskiskk**kkickk***kkkkkkkkickkkkkkickkkickkkkkkickkkkkkkkkkkkiekkic is <br /> Supervisor/Lead Senior Comments: <br /> • ,. �s+tib <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? 'Logged in LAND USE BOOK? <br />