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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EIID RECEIVED APP.REFERRAL.✓ - 3 COMPLETE & SUBMIT BY <br />` DATE DATE <br /> ATTN: � <br /> SITE ADDRESS: .2 9 0 in . f t <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 /> E showing population density, location of house, wind direction, etc.... <br /> Public water: A/0 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> ge-aJ nl — cr y <br /> rs- a[ <br /> r f4 i y Jejtl 1 C S X1,5 ifM LO C! ra.M r ,r A0//4P r- 15,40 <br /> V <br /> WO �t no rn�B"1� mrnr' rn S fon o`ovr� <br /> rair.. �snQ/ t <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> G <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 3QAIl C1EC'K 4FF'LIS7'- �=oofreed tep rt?{ CoiraLAIYDUSr#� <br /> EH 06 06 Rev 1199 " � Correct CONDIION(S}?r Logged rnA14�Il,I1SEBOOK2 , <br />