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NOTE: PULL ALL PERNhrfS (SEPTIC, WELL, ETC...) :. AKE COPIES FOR FILE <br /> LAND USE REPORT APP# -S'/4 -qq-6j5 <br /> EI-IDD RECEIVED APP.REFERRAL: -3 o_ /O�!p COMPLETE & SUBMIT BY q - v2 (— q 9 <br /> DATE „��'- DATE <br /> 1-//�� <br /> ATTN: `) P.t' - D-i,5Ae f <br /> SITE ADDRESS: i a g r7D L L oek P in C� r t>t Q �rol <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 /> J / J 0 �2- <br /> Z - D �1 <br /> rg b� i WS <br /> G�L �/I?_y / � L L l .��► / r.n <br /> j a rAp t” LLQ '' S 6 rP-40 4/ A C lCZ <br /> I recommend: Approval Denial Continuance Inspector's Signatures <br /> Supervisor/Lead Senior Comments: <br /> i1_ 0 2 <br /> 4S /,5--0/ <br /> I a2qq -No <br /> SUPERVISO ADDS �R APPROVAL: VJOAA„ <br /> _ EiOA / CHECK OFF LIST: _Proofread report? Correct LAND USKi_;1 ,n R,, 1 90 Correct CONDTIO /S)? Logged in LAND USE BOOK? <br />