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Z-117 <br /> ,NOTA: PULL ALL PERS (SEPTIC, WELL, ETC...) . &KE COPIES FOR FILE <br /> LAND USE REPORT APP# ,�2 - 0/- <br /> EHD RECEIVED APP.REFERRAL: 0� COMPLETE & SUBMIT BY 6 —0 � <br /> DATE 1q , DATE <br /> ATTN: <br /> SITE ADDRESS: 7 B b' (/�. �L�►-ted �� � �� <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 /> ,;,,C <br /> Y <br /> t <br /> t <br /> I recommend: Approval Denial Continuance Inspector's Signature ' 1 <br /> �c�'c�cxa'coca'ca'c�cxx*der'e�'c*x��r9e�'es'e�'e�4�e�e�+r9e�'a**�'e***x9c�c�'cxikx�e�'eK**ie ie ie�e�4x�'cr'c�'c*a'cxa'eiex*i'c�'c�c�c�c�k�'c*�c9ex�'ca'c�k*�F9r9c�c*�c*9e 4e 9e�e�e <br /> Supervisor/Lead S nior Comments: <br /> t- � f b nJ—✓ �^ S <br /> i <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA IL CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EII 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />