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*rl <br /> NOTE: PULL ALL PERNtkfS (SEPTIC, WELL, ETC...) M-XKE COPIES FOR FILE <br /> II,AND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: S —� -o1 COMPLETE & SUBMIT BY -5 <br /> DATE DATE <br /> ATTN: /l/1{' Mutile r <br /> SITE ADDRESS: la-IL-5 F . Jo6&yvi- ted . A CG.^ec <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments <br /> in Oq <br /> SUPERVISOR/L.EAD SENIOR APPROVAL: r. <br /> OA II CIILCK OFF LIST., Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Lagged is LAND USE BOOK? <br />