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t <br /> U <br /> 16 NOTE: PULL ALL PERAS (SEPTIC, WELL, ETC...) l-,.AKE COPIES FOR FILE <br /> LAND USE REPORT APP <br /> EI-ID RECEIVED APP.REFERRAL: 6 —17"LX) COMPLETE & SUBMIT BY -7 <br /> DATE / __ DATE <br /> ATTN: j n Gr L Q K TM,P i f "Le <br /> SITE ADDRESS: 1/ Q I/e, vr�--rE;7 cy (a. s-2 <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: r-A- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �c�c�'c�c3e*�c�c9c4t�c*9cacid"c�c�c*ic3c�c*ic�c�43c�'c�49e9cxxic�e9cir�cx�c�c�cic*�+c**�c�cx�c*9c�e9cie9c9c�c9eir9r**ic�cic�kienFxicic9e9c�cx*�c�c**�"c�c�4�c�'c�c�cic <br /> Supervisor/Lead Senior Comments: <br /> c <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EFI 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />