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NOTE: PULL ALL PERMI 1 S (SEPTIC, WELL, ETC...) N.,.KE COPIES FOR FILE <br /> LAND USE REPORT APP4_P1q - --,--r <br /> EHD RECEIVED APP.REFERRAL: UJ COMPLETE & SUBMIT BY C'/ 17/0 3 <br /> DATE DATE <br /> ATTN: �—e�nne- ( t r <br /> SITE ADDRESS: 9 R/ U S r te f l`� ' ` <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: n Public sewage: _12� <br /> SUMMARY OR COMMENTS: <br /> ��i <br /> I recommend: Approval Denial Continuance Inspector's Slgnatu e­-� <br /> �c is F icx 'e F�cx4exiexse c�cxx�c ie F is ie is ie ie is ie ie Y c is F�xxa'c*�c ie is is icxic is it isxic icxic ixx9c is isxicxic is yrx�c�cx is itx*is'exiexiexF isx cie*iexie is <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged rrr LAND USE BOOK? <br /> EI 106 06 Rev 1/99 <br />