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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# P11 -03 �S I <br /> EHD RECEIVED APP.REFERRAL:4AE <br /> n! COMPLETE & SUBMIT BY q ` ( DJ <br /> DATE <br /> ATTN: � <br /> SITE ADDRESS: I q 3 �� L �-_�., �� �� yt��%'r� 1 <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 Si a % ✓i _„� <br /> 9c�cxx�cx�c�c 9cx�c xyc�cxx�cx�cxic KcxcXF'cxir�c 4cx�cxic [icx4cXicxx9cxFx�c ycxx�cxx�c it is�c is$e is is�cx�cxxic is cx�c�cx'�c isx�cx Kxic sc >cx�cx <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> M <br /> c3 <br /> ?-01:o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EFI 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />