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"-` "5�' <br /> `LAND USE REPORT <br /> EHD RECEri'ED APP.REFERRAL: a I U COMPLETE & SUBMIT BY 22 <br /> DAT DATE <br /> ATTN: �l o f n M A <br /> SITE ADDRESS: � _ r� S �3Zr. <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> icx kx�k it dex�Y�e kie xFr it�F kik 9tx�k Jc�Y**�c�'t+t 4c�':kie�'s�F k�Y vt is ie xicxx�r*�ir:F is�'c$c:Fx:e is�F is it is do vc trxirxnc�e�c it�F iF it�Y�e�e:Fx�r�F is*xXic�e ds ie is it�c oc <br /> Supervisor/Lead Senior Comments: <br /> LAND USE CHECK OFF LIST <br /> ✓Did you proofread the report? <br /> SUPERVISORILEAD SENIOR APPROVAL: DID YOU USE THE CORRECT: i <br /> Land Use#? <br /> /Condition(s)#? <br /> i/15id you log it as completed? x <br />