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-�N <br /> NOTE: PULL ALL PERMIT (SEPTIC, WELL, ETC...) M1�T.,E COPIES FOR FILE <br /> LAND USE REPORT APP# i 4-oi -_ a <br /> EIID RECEIVED APP.REFERRAL: 4 — COMPLETE & SUBMIT BYZj 7 -/ p -8 4 <br /> DATE CIL-" <br /> / DATE <br /> J <br /> ATTN: O S-� C I L i GL ('1 e S <br /> SITE ADDRESS: q L( n q (:: aC (1 ft, t'"A -� P, � d <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 /> oed <br /> eA b4 oe/ <br /> z -J. �C <br /> Q t- 7' - e 4d� , ? ��gA <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead/ Senior Comments: <br /> e <br /> 81 <br /> 1 <br /> Ell <br /> 0111 <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> 0,111 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev I/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />