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f � <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 6 -9-7-00 COMPLETE & SUBMIT BY — i:4 _vim <br /> DATE DATE <br /> ATTN: Ibn 2; �� <br /> SITE ADDRESS: I I ")-no r� , <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 /> ll� aCr� <br /> I recommend: Approval Denial Continuance Inspector's Signature M <br /> �c�F�c*�c9eicic�ca'c�c�EaF9rica2�'c�c*9c�'c�e9cicic9c�e�F�k�+c�'c�cdc�F9cr'c�e�'e4cx�c�'c�cx�e9r*�c�E*�c�e4c�c*�'c3c�E4c9c�4�e9ca'c�F�c�ca'c3e*�c�cie�c9c9c9ede�h�lc 9t 9e 9t dc�irdc '*�'e <br /> Supervisor/Lead Senior Comments: <br /> tj!V <br /> �\ <br /> 74 — PSZ - <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 />