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L � <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) A'TAKE COPIES FOR FILE <br /> LAND USE REPORT APP# Sly- o► -y 9 l <br /> EHD RECEIVED APP.REFERRAL: �D—' 3L -Dk COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: l-Panna t. MAlt I C <br /> SITE ADDRESS: 3 5 9 N 1—::L l'fl a,- PVti t2d. • <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: /'1 <br /> Public sewage: �'<= <br /> SUMMARY OR COMMENTS: <br /> ,j <br /> h� <br /> '// C,, 7 <br /> z <br /> LEI-' <br /> '/�7r� <br /> I recommend: Approvals Denial Continuance Inspector's Signatu I" <br /> Supervisor/Lead Senior Comments: <br /> C <br /> nr,( � �it�: �e a�ccti2�-mss <br /> LS a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA Il CHECK OFF LIST: _Proofread report? Correct L,4ND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? II <br />