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LAND USE REPORT APP# A e -03 0" --r-fri <br /> ' + EIID RECEIVED APP.REFERRAL:�� 'qo( COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ,r— r <br /> ATTN: E P r <br /> SITE ADDRESS: _q10/V <br /> In completing the Land Use investigation, draw all Public Health factors on the elhibit (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: 12e h � Cu Public sewage: A4c-lri -e- <br /> �i fh�, <br /> SUMMARY OR COMMENTS: <br /> -eo ii — 0 <br /> 11 - 09 C; - � Area 1 s ,5w4c4bIr 40- s6akc <br /> IS- pl � <br /> C?'M 11 1e ' G� A✓14 C <br /> 90- 0 - �r10 °� ! rens -r� �i tom. �.'� i�ccr� e��� PSA <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *****3e 4s*irxie*ie is 9r***aex4r*********�rxxie ie irx*ds***�t is**�rx ie is�F ac is****>eir*ie***r.ic*ic****dc drxxa:*ie ie*x3r***** �c <br /> Supervisor/Lead Senior Comments: <br /> i , � <br /> bF MW <br /> LAND USE CHECK OFF LIST: <br /> 1 Did you proofread the report? <br /> SUPERVISOR/LEAD SENIOR APPROVAL: + DID YOU USE THE CORRECT: <br /> Land Use#? <br /> Condition(s)#? <br /> �id you log it as completed? <br />