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NOTE: PULL ALL PERM-"S (SEPTIC, WELL, ETC...) M XE COPIES FOR FILE <br /> LAND USE REPORT APP# (S6) <br /> —7 <br /> EHD RECEIVED APP.REFERRAL:JQ �-Q� COMPLETE & SUBMIT BY / <br /> DATE //�� DATE <br /> ATTN: i M �Gl/1 6LIt L /t <br /> SITE ADDRESS: L I--o ze d, <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 /> c otc 7 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF L, "YD USE#? <br /> ENTERED IN LAND USF: LOG 'E BO <br /> EH 0606 Rev I/99 CD/ DROP DEAD ON (-,Al I n;DAR i <br />