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NOTE: PULL ALL PERNOS (SEPTIC, WELL, ETC...) iv...KE COPIES FOR FILE <br /> LAND USE REPORT APP# y C -z�l -a <br /> EIID RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY 16 .-0 1 <br /> DATE DATE <br /> ATTN: L, 'A n f- rylvele r— <br /> SITE ADDRESS: // q . S �7 I �_ n- d . . r e r1 C,/- C'�►.,-,-,o <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: �f <br /> SUMMARY OR COMMENTS: '-N, <br /> I recommend: Approval Denial Continuance Inspector's Signature 'f <br /> Supervisor/Lead Senior Comments: <br /> © � <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />