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NOTE: PULL ALL PERlWITS (SEPTIC, WELL, ETC...)`T LAKE COPIES FOR FILE <br /> LAND USE REPORT APP# aX - �V-l <br /> EHD RECEIVED APP.REFERRAL:S — — COMPLETE & SUBMIT BY 5 ---Al- / <br /> DATE �t DATE <br /> ATTN• 7-a/1'! [-.j <br /> SITE ADDRESS: 3/0/3 .s . 7Tr',4i C�z /&lv& • T�� c y <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 /> NvrE; i�6 ; I fiPigt` S�. 5 56!�&A t-oo P <br /> ?,Vol <br /> 3 2 03 <br /> 1, y1, o <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 /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />