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r7 <br /> NOTE: ALL PERMITS (SEPTIC, WELL, ETC...) NIAKE COPIES FOR FILE <br /> LAND USE REPO <br /> RT APP#_ (� v03�3 ��r— <br /> EHD RECEIVED APP.REFERRAL- C� 3 COMPLETE & SUBMIT BY DATE <br /> D 6 <br /> ATTN: ,P <br /> SITE ADDRESS: <br /> on te exhibt(i.e.: sewage In completing the Land Use investigation, draw all Public Health £ac <br /> rsa erhdra completedleted map of ap asal, <br /> water supplies, etc...). Where necessary, on an attached piec plainp p <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR OMME <br /> NT <br /> I recommend: Approval <br /> Denial Continuance Inspector'sector's Signature <br /> Supervisor[Lead Senior Comments: <br /> as: <br /> :d7 <br /> 011 <br /> 00 <br /> SCJ G r <br /> r <br /> 4-1 <br /> v <br /> A <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> �Proo read ie ort'§ ` �"� Carreel LAND USE,# <br /> OA II C1"IECK OFF LIST n .I ;p <br /> Correct G�NDI7ION(S} Logged in LANl7 (ISE`B©DKE <br /> 1=1-I 06 06 Rev 1199 <br />