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SS <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EIID RECEIVED APP.REFERRAL: r✓I COMPLETE & SUBMIT BY a 3 <br /> DATE c DATE <br /> ATTN: JL n (A I,� � to 1 « <br /> SITE ADDRESS: o�?J((�� S S S KcI T�c+ <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: 9 <br /> �►� ea V 01 <br /> Gt, <br /> • <br /> `1 P <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> [-6A 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EI 106 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />