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SS <br /> NOTE: PULL ALL PERM'S (SEPTIC, WELL, ETC...) Yom' KE COPIES FOR FILE <br /> ! <br /> ,AND USE REPORT <br /> EHD RECEIVED APP.REFERRAL: d_`AQ'GI COMPLETE & SUBMIT BY� —0/ _ <br /> DATE i DATE <br /> ATTN: t e n n iAr J <br /> SITE ADDRESS: 16101 Gi) , _-�C-0^ /Z+ ec�a r r� <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 /> p r <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ie�(r�eie9c�c9e�c�*��c�t�r�e�ek$edr�c*9r�rickdr*nFdc$cdcaF9r3r�rxJeie�'r3cIc9t�tslrx:Ir*ic�cdc�r�s$cue*icy'c�c**3c�c�ic9r*9r�c$tds*9r�s�9c�'c9t7r�c�ieie�eivxic4t*vcic <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> f OA II CHECK QFFLIST Proofread report k: Correct Lr1ND(ISE#9 a <br /> EH Q6 Q6 Rev 1199 a Correct CQNDITIDN(.S) Lagged in <br /> LAND BODK7 <br />