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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EI-ID RECEIVED APP.REFERRAL: I,)-90 Jqq COMPLETE & SUBMIT BY / V_/�—00 <br /> DATE 1 I DATE <br /> ATTN: �r (10Q-k F(nf-,_S y- <br /> SITE ADDRESS: I�0``] Af j�cL �4-xN i2cl L 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 /> l - L'�, <br /> 2-- -- .� <br /> z- g Wme �i 7P- J <br /> �--- <br /> s 719 �c.>r�r l AX--P T <br /> 1✓J t',4,yn s - S A,C) 6.Al c r,/IP-d r--O Z <br /> ep <br /> � Q��� �� Ct�,� ,.(L O15 <br /> I recommend: Approval_�'Denial Continuance Inspector's Signature (1 ? . <br /> �F�F�cxsxx�c�c�c�F is�c 7cx�'c ak�F fc�F�c 7cx�r 9r irxsr�CX)C is�c�r�k 9c is�c�cx9cxx�F*fie�ck�cx�c�F�F**�c�c rc is is�c�c�cxxsc�c�c is is�c�c�c 9cx�Fx�c�cxic is iczic�*�cxit cltt <br /> Supervisor/Lead Senior Comments: <br /> A- <br /> 11- olp <br /> 1z oc:i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF L T. Proofread report? Correct LAND USE#? <br /> EF106 06 Rev 1/99 orrect CONDITION(S)? Logged in LAND USE BOOK? <br />