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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> 'T-i,4-,k <br /> LAND USE REPORT APP# v( �— -� c1 Zacd =9:5.4 -- <br /> EI-ID RECEIVED APP.REFERRAL: -a —U COMPLETE & SUBMIT BY <br /> DATE // DATE <br /> ATTN: to <br /> SITE ADDRESS: -)-)q ( a S , �- S �- L ,4 <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 /> � �, � S. s q /I JJ.t• /,,..�y2. �X.�Gt <br /> I recommend: Approval Denial Continuance Inspector's Signature , <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />