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NOTE: PULL ALL PERmi rs (SEPTIC, WELL, ETC...) MA-"CE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EIID RECEIVED APP.REFERRAL: "d 1 COMPLETE & SUBMIT BY A:5)q P 7-t0-O I <br /> DATE DATE <br /> ATTN: K i aN(X Z L� t/Jt, ALC <br /> T <br /> SITE ADDRESS: ° 3 S et q C I J� L n kA'cl` e,� ) C-Zkd23 n o <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.... j <br /> Public water: �� Public sewage: <br /> SUMMARY OR COMMENTS: <br /> G7 0 -noel�E Ax e.,-7 7 T� <br /> 2 / <br /> I recommend: Approval Denial Continuance Inspector's Signature�-7�19)644 <br /> J <br /> Supervisor/Lead Senior Comments: <br /> r <br /> AL <br /> i <br /> io or- � <br /> 75 <br /> - i �r <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 11 CIIFCK OFF LIST.• _Proofread report? Correct LAND USE 9? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />