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NOTE: PULrL ALL PERIV*--�S (SEPTIC, WELL, ETC...) .f—KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EIID RECEIVED APP.REFERRAL: 9/�/b, COMPLETE & SUBMIT BY I n l 0 "o f <br /> DATE DATE <br /> ATTN: Tnn,4r T&JLu. <br /> SITE ADDRESS: i/612 o A/ S MA-7 Qou l-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.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> .Z G G <br /> s� <br /> d` � fob <br /> �., .• by _ -� � - art <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor[Lead Senior Comments: <br /> 0 / <br /> A- <br /> 41 <br /> 11 " 0 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> En 06 06 Rev 1/99 Correct CONDITION(S)? _Logged is LAND USE BOOK? <br />