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,NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> t <br /> LAND USE REPORT APP# J/4--00 <br /> EHD RECEIVED APP.REFERRAL: L/—/1-00 COMPLETE & SUBMIT BY S a -O <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 5 q-7 7 G z0/,i <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 /> Ct <br /> a to Poor 222 <br /> C, 2 <br /> Z riffz <br /> I recommend: Approval Denial Continuance Inspector's Signature J <br /> *ic X�c icXxicxxx*�F ie�r 9c�F*ie 9c icx�c 9e 4e�F*�'c�Ex�e dr 3c 9c��F*9c�c 4c�'c�c�r*9c�c�F�F�'c�'c*9c�c�'c�'c it it isxa'c*is is fc is*�c is is is k4c 9c icx�c ie ie*�cx�c�'e 9c is�c�r:c 9c�e <br /> Supervisor/Lead Senior Comments: <br /> t <br /> oad o/ <br /> T <br /> 4a af� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: __IZIProofread report? L' Correct LAND USE#? <br /> EFt 06 06 Rev 1/99 '' Correct CONDITION(S)? Logged in LAND USE BOOK? <br />