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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# O <br /> EIID RECEIVED APP.REFERRAL: ^' I COMPLETE & SUBMIT BY (� ' �- —d/ <br /> DATE y - DATE <br /> ATTN: —��v1f� YYU-td f---c <br /> SITE ADDRESS: J` I(�c) Hnj ,4 <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 /> �D ,a2 <br /> A)61F; 4J7RIENNt SyS AuE To .uo T Euouv�f f P«� 4�4ESTio-v�9/3« <br /> I recommend: Approval Denial Continuance Inspector's Signature I <br /> Supervisor/Lead Senior Comments: w U <br /> C?� Ge <br /> 8 . fir • d3 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> I <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />