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iV <br /> { j <br /> L (+ <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) Nrr:KE COPIES FOR FILE <br /> LAND USE REPORT APP# P# -C, 3 5 ') �5 � <br /> EHD RECEIVED APP.REFERRAL: q COMPLETE & SUBMIT BY D — I <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 3 Cl -7—D"Aact <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 � Flo-Z -d3 <br /> S�TI�!��?�r�7 7�GtrT �.�.� .���f•���/�,���-�.�5���i,�rLt���ir/��v7 <br /> I recommend: Approval tv/ Denial Continuance Inspector's Signatur <br /> 9cxic rr�c icxicx4cxic it icxicxicxic is�'c�Fx9c�e��'c�"c ie�cxic�c is 9c 9c�'c is ie 4e*�F�F 3c 9c�c 4c�e 9c�c�c ak 9cx�exicxicxicx�e�e 9c�c�F�c�c nY�c�e is�e ie ie�e>c�c se ie�ex�c�e�c 9ex�F <br /> Supervisor/Lead Senior Comments: <br /> • V � � ^ M P t r C:� <br /> YO <br /> l3. ao . aY <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> E11 06 06 Rev 1/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />