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f�x/23 <br /> NOTE: PULL ALL PERMt,5 (SEPTIC, WELL, ETC...) Mx.i E COPIES FOR FILE <br /> LAND USE REPORT APP# L --Q 3 -- ( 7th�S�J <br /> EIID RECEIVED APP.REFERRAL: �' COMPLETE & SUBMIT BY £j�/n /0-3 <br /> D E <br /> ATTN: )x:::, C 1) )0 ( A [Z�4 <br /> '��uR <br /> SITE ADDRESS: <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 /> fy-�O n kc>r Q-\\ <br /> Cc•)ntiarn,�\- uQ i5'�� 1� Q.^f�� VQn\Wlap s <br /> Ll�� .. CJ.V\-C.�- �1 h�L[� 1��P� i.�i�l� b�,^ `-f. �.F•4�4A.-� _ <br /> D14 U t; — <br /> I recommend: Approval Denial I Continuance Inspector's Signature ---�� <br /> 9c 9c�c is is is is is is�c�'c�'c is is is�e is icx�F�cxxic is is is 9r�'c�'c-k is�cxie aF�'c�c is*�cx'�4�c is is�c is is icxic is is�c is is icxic ic:�xic is is icxic is do is�c 9c�cxa'c�cxx�c i�ic 3c*�c�c is�'c is <br /> Supervisor/Lead Senior Comments: <br /> r � <br /> e <br /> r'Yv'•�` � ,",Itf�_Al <br /> �.fes • <br /> I A <br /> td~ <br /> :.. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EUI 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />