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T4 <br /> NOTE: PULL ALL PERM1 S (SEPTIC, WELL, ETC...) W_t{E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> END RECEIVED APP.REFERRAL: 1 )-u `010 COMPLETE & SUBMIT BY J <br /> DATE DATE <br /> ATTN: 1 m nI y��n <br /> SITE ADDRESS: G-7 <br /> 3 <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.... 7' <br /> .111 <br /> 11 kawo <br /> Public water• .. .• t�'ps Public sewage: � b� t <br /> SUMMARY OR COMMENTS: <br /> v d <br /> I recommend: Approval 1Z Denial Continuance Inspector's Signature <br /> i'c9c�c�c�'c�4�'c1c�c�ede�F�Fx�c�eieicdcnF9exicic�F�'c�c�'cic*�Fxicicicic*x�tic*�F�ca'e9e�+c�c�c�E�c�eicicicicic�cicicXicicicrcx�Yic�'cxXxx�cx*'sex' i exxitic'icx <br /> Supervisor/Lead Senior Comments: <br /> b40L-oI C'W r1o , <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />