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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# q 9 - <br /> EHD RECEIVED APP.REFERRAL: / Iv COMPLETE & SUBMIT BY 0 " / <br /> DATE DATE <br /> ATTN: J S r- <br /> SITE ADDRESS: ej J S 0 14 CG1 <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: �wA Public sewage: <br /> SUMMARY OR COMMENTS: <br /> i 2 V--e y- <br /> . a `S 2 77-z-,4 7--o 7-A--,) ",IWA)g-P . <br /> d JY ✓ 5 <br /> I recommend: Approval_ -e-15enial Continuance Inspector's Signature rr-ea q <br /> Supervisor/Lead Senior Comments: <br /> v <br /> 6 <br /> ba. e4M 0091, -ftV- <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 4? _ <br /> OA II CHECK O F LIS T.- ✓Proofread report?k Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? V Logged in LAND USE BOOK? <br />