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...F' I <br /> t— G I. <br /> I <br /> NOPE: PULL ALL PERK ..; (SEPTIC, WELL, ETC...) 11 E COPIES FOR FILE <br /> i <br /> LAND USE REPORT APP# <br /> END RECEIVED APP.REFERRAL: -! .r-5`w COMPLETE & SUBMIT BY y " /ter' -Oq <br /> DATE / , r DATE <br /> ATTN: �,nn � Vy Cn�f! Ac o ^ <br /> SITE ADDRESS: S5 , JV <br /> In completing the Land Use investigation, draw all Public ealth 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 /> V <br /> Ze • ' <br /> 400je, door <br /> a <br /> f <br /> J � <br /> ( i <br /> I recommend: Approval D--*A Contin ance Inspector's Si at <br /> Ficisiciris��'sic*icicicicieicx$kieirie*FieeisxiskYieisxisirFk'Fic>tiieisisuicieic�':icicisicickaccFcic*iciccic$cicicicF - c�c�ra� �t t$r$c9tK�t$cxK�c <br /> Supervisor/Lead Senior Comments: II,F.I <br /> a. <br /> fQY <br /> � w <br /> s � <br /> V <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> V000' C— JeZ�pfN <br /> �. <br /> All CHECK OFF I IST Proofread report? " Correct 4ND USE#r <br /> l <br /> EH 06 06 Rev 1199 = Correct C4.NDITION(S)? oggetl rn T�tND USE BOOK? <br />