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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC—) MAKE COPIES FOR FILE <br /> LAND USE REPORT: APP# CO-6 3 <br /> � nn <br /> EIiD RECEIVED APP.REFERRAL: 9_0 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> } ATTN: <br /> SITE ADDRESS: l� 7G _ urn ,af IK - <br /> E —iia <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 /> i <br /> fti <br /> 7 <br /> j I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> !J <br /> t: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LISTPraoread repoil Garrect Z;41YD CTSE#9 <br /> EH 06 06 Rev 1/99 � ;€ � � Corte`ct COIVDIT74N(S}����r��'3 Logged 1n LAND i1�E BO©K? <br /> .9 <br />