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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br /> LAND USE REPORT APP# Al 5-qY J9 <br /> EHD RECEIVED APP.REFERRAL: 10-,?b -qC/ COMPLETE & SUBMIT BY lZ J/Z `�'/ <br /> DATE �t DATE <br /> ATTN: _�_ A4�Ael /I)� C �i.11 <br /> SITE ADDRESS: 'ol 02 C t r /r/ <br /> In completing the Land Use investigation, draw all Public Health factors on the exhi it (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 /> O F u r E 5E y-E '66 (c,o r76 <br /> UG SU1 L Sf�IT►gPj�J.� r��i`��(Z/c TEST <br /> 27iUZ )D/3OPt—Pt7-P—iL-7�z 7�s7- <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *�c*ic�c�c�'c�c�c�c�cic�E�cx�c�c9c�c�c�c�csc�F�c*�c*�cxie�Fixicxiea'r�ca'cx�c�ca'c�"c�F�c*ir:kFc9c9c�c�c�"c�'c9c�cir*icxicic�c�c k�c�r�'c k�c�F�c9c9ca'c*�c9cic�ca'cvF�eaF�Fic�cic <br /> Supervisor/Lead Senior Comments: <br /> F--)� <br /> It—b3 <br /> of <br /> SUPERVISOR/LEAD SENIOR APPROVAL: _ <br /> OA II CHECK OFF LIST. Proofread report? __L_,--Correct LAND USE#? <br /> EFI 06 06 Rev 1/99 , s_ Correct CONDITION(S)? Logged in LAND USE BOOK? <br />