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Jr <br /> S <br /> NOTE: PULL ALL PERMIT (SEPTIC, WELL, ETC...) MA'>KE COPIES FOR FILE <br /> LAND USE REPORT APP# 5A-UL) (.S <br /> EFID RECEIVED APP.REFERRAL: 11-L -00 COMPLETE & SUBMIT BY /,-S- —00 <br /> DATE DATE <br /> ATTN: J e?rz r <br /> SITE ADDRESS: 95/ ) /e C� �l Em Gh C_rPvn <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 /> Nor [��ul2aav ti'AP/ TIfEKc /S 4 L/fRCE exi(oAV S/lsN A/EXT To rrfr5 5/TE <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> D L� <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 />