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NOTE: PULL ALL PER1V* (SEPTIC, WELL, ETC...) i. KE COPIES FOR FILE <br /> LAND USE REPORT APP# �;9 -QNr 3 <br /> EIID RECEIVED APP.REFERRAL: OCOMPLETE & SUBMIT BY /17/ <br /> DATE DATE <br /> ATTN: V-1?��r 1'!slt r <br /> SITE ADDRESS: Y/2<1 /V ah'ss f CQ/1z S/V c/./tin <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 /> /v o <br /> I1 : �1 <br /> 7-0 �0/ <br /> / ab`?� ' <br /> 7 A)o 7/(' rN 04 T 4 <br /> I recommend: Approval Denial Continuance Inspector's Signature r <br /> Supervisor/Lead Senior Comments: <br /> o - <br /> 0: 7 <br /> � U <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> D� 20 '°y <br /> C', 1 ', Or OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EFi 06 06 Rev 1/99 n �t 11 -Correct CONDITION(S)? Logged in LAND USE BOOK? <br />