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1 0 /, & <br /> NOTE: PULL ALL <br /> PERMITS SEPTIC WELL, ETC...) mttKE COPIES FOR FILE <br /> LAND USE REPORT APP# 0 V-00 -D(� <br /> EHD RECEIVED APP.REFERRAL: /0_/vy'o COMPLETE & SUBMIT BY — 7 —6) <br /> a <br /> DATE DATE <br /> ATTN: T- ,nth WP-Lyme ;� <br /> SITE ADDRESS: W loo? C Ns Aicbe e. Q* e.nJ e. (0 „n h c0 <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 /> mr <br /> !� <br /> ;7 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> ✓k.o <br /> LP V-14 j • <br /> AQ <br /> M. w <br /> If <br /> SUPERVISOR/LE SENIOR APPROVAL: <br /> OA 1I CHECK OFF LIST. Proofread report? , Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? , <br />