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!NOTE: PULL ALL PERMI-I S (SEPTIC, WELL, ETC...} Ni--YKE COPIES FOR FILE <br /> ,ANn USE REPORT APP# <br /> COMPLETE & SUBMIT BY* a-sap <br /> . <br /> EHD RECEIVED APP.REFERRAL: 3 2.1- DATE <br /> E <br /> ATTN: sD.eA C s <br /> SITE ADDRESS: <br /> In completing com letin the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: sewage d s poasal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of a <br /> showing population density, ation of house, wind direction, etc.... <br /> Public water: v Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 611110 <br /> I recommend: Approva Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA TI CHECK QFF�I57 <br /> `Proofread rgport' j3, ' Correct SAND iISE#? <br /> Correll CONDITIONS)� '` ' � Lagged to�LriND TISE$OOK?, <br /> EH 06 06 Rev 1199 � '! :�- t, <br />