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` NOTE: PULL ALL PERMI)r� (SEPTIC) WELL, ETC-) MSE COPIES FOR FILE <br /> AND USE REPORT APP# 05 ' OZ) <br /> 1b� COMPLETE & SUBMIT BY 4 o a r <br /> EHD RECEIVED APP.REFERRAL: DATE <br /> ATE <br /> ATTN: ti n ru M -e k� <br /> SITE ADDRESS: 2, ZD 5LLFo - s <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 o house, wind direction, etc.... <br /> Public water: 4 (,A Public sewage: <br /> SUMMARY OR COMMENTS- <br /> 5S <br /> OMMENTS:GZ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> D <br /> A, ,1 :o6 <br /> 6 . 1221-a;- <br /> C-. 11: 6 3 <br /> O <br /> d <br /> QRA&te� *714 <br /> t <br /> SUPERVISORILEAD SENIOR APPROVAL: d. <br /> 4A II CHECK OFF LIST`5 s'Proofread report?� Correct LAND USE#9 <br /> EH 06 06 Rev 1199 <br /> T �s� '° Correct'CU�YDIIIDN(S)9 s "`Lagged in LAND USE BOOK? <br /> ,� `'i�.�s� ...:;�'�✓'3z93',,.;?'aa�"�., !d<w:t .�<� <br />