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Z_ <br /> NOTE'S PULL ALL PERK S (SEPTIC, WELL, ETC...) 1 EKE COPIES FOR FILE <br /> LAND USE REPORT APP# S-4 - of-ff <br /> EIID RECEIVED APP.REFERRAL: /Z_ 4/_0y COMPLETE & SUBMIT BY -2 . / 7o/ <br /> DATE ATE <br /> ATTN: J/=/VN1 Fisk i0e_CE'Y <br /> SITE ADDRESS: lq,(2q r" WIL b► 66A �'�� STQ 6k rZ)/1O <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: i ; Public sewage: / <br /> SUMMARY OR COMMENTS: <br /> by <br /> 73 / <br /> 0 <br /> I recommend: Approval ­�Denial Continuance Inspector's Signa ure --- , <br /> Supervisor/Lead Senior Comments: <br /> a� :o7 <br /> 3 :0 •� <br /> , <br /> Aaw <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />