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NOTE: PULL ALL PERM* (SEPTIC, WELL, ETC...) N&E COPIES FOR FILE <br /> LAND USE REPORT APP# 5-14 -a) —,5' <br /> EHD RECEIVED APP.REFERRAL:IL— (� COMPLETE & SUBMIT BY //— / -00 <br /> DATE DATE <br /> ATTN: ��� d� <br /> SITE ADDRESS: 5!�Sy A . (/U il l -s"l-I <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 CO MENTS: <br /> 6 `l d <br /> ( a (� mq-0- A0W Aj SVo4w <br /> wL ` 1; 4-) <br /> 110 ' 04o 7 ��� - / <br /> S <br /> e e ��dc, � <br /> � /te � .� t 5�� . <br /> -grid <br /> (0 '. 03 <br /> I recommend: Approval '� Denial Continuance Inspector's Signature0// c� <br /> de�4�'cir4c�F�R:k�c�'e�e�'e�c�c�'e�e�coF3c�c�cic�F�cx�k�c�c9c9c��k9c�k*x�c�Yicxkieicdcie�c�F�F�E�c*icx�c*��ic*x��c�e*�F�'c�e�e�F�F�Firic�cdcic�:c�c9c**�e�r�c*�c�'cic�cic <br /> Supervisor/Lea�ddSSefn�ior Comments: <br /> opo o a/ <br /> 3 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EFI 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK?. <br />