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SEI <br /> NOTE: PULL ALL PEIMITS (SEPTIC, WELL, ETC...jMAKE COPIES FOR FILE <br /> LAND USE REPORT APP# IJ - Q q - 79 <br /> EHD RECEIVED APP.REFERRAL: /Q -5"R (q COMPLETE & SUBMIT BY /O -/9 9 <br /> DATE DATE <br /> ATTN: .1 P 4-4� r-L. A e.r <br /> SITE ADDRESS: 11-D 8X \5. f-rre ', C�in4 <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: dA Public sewage: Aj <br /> SUMMARY OR COMMENTS: <br /> Al 611 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> F7� <br /> ECK OFF LIST: ��roojread report? ✓ Correct LAND USE k? <br /> EH 06 06 Rev 1/99 _ —[,40!�Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />