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TE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M,�E COPIES FOR FILE <br /> NO Pre — <br /> APP# (J- L? -)�P <br /> LAND USE REPORT 7F7;0, <br /> COMPLETE & SUBMIT BY <br /> EHD RECEIVED APP.REFERRAL-DAT DATE <br /> ATTN: <br /> SITE ADDRESS: 6 O <br /> In completing the Land Use investigation, draw a 1 Public Health <br /> factors <br /> rson hdr w completed map ofe exhibit G.e.: sewage Basal, <br /> water supplies, etc...). Where necessary, on an attached pieceof plainPaper, <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: ( Public sewage: <br /> SUMMARY OR COMMENTS: <br /> oy <br /> I recommend: Approval Denial Continuance Inspector's Sign ur ' <br /> *�cicicicicicic�'c4cic�'c�Ficic�c�'c�'c9c�ciricicicicxicsc�e�'cicicxicicicicrr�cicic�'c�c�c�c�'c-Jc�'e�'c4c9e�'c�C�'c9cic�cic�e�e�'c�'c�cxicre�'cicic3c�c�c�eicic�cicicicicic cXic�cxicicicic <br /> Supervisor/Lead Senior Comments: <br /> d <br /> 6 <br /> �- <br /> o : � <br /> e aa: p <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 4r���... <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> GFI 06 06 Rev I/9I <br />