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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> Pre - <br /> LAND USE REPORT APP# S /4 - I Ct - R 7 C4-12Q I Ica fig <br /> EHD RECEIVED APP.REFERRAL: `— I ` 9 COMPLETE & SUBMIT BY ) ; �-- <br /> DATE DATE <br /> ATTN: :L r, S he- r <br /> SITE ADDRESS: cu (�, L S I-� 1 uT 1=' ice n <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 r Ion, etc.... 0/,.5 <br /> Public water: 1,� � J «l� ^Pub Ic sewage: ,� ��,G,� I e r� r <br /> SUMMARY OR COMMENTS: <br /> — / Ll r) <br /> I recommend: Approvals Denial Continuance Inspector's Signature <br /> iz-4 2.1e - <br /> Supervisor/Lead Senior Comments: <br /> L L4 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ►/� — <br /> OA II CIIECK,Q.1F LIST. V Proofread repo ? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />