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LAND USE REPORT O APP# <br /> EHD RECEIVED APP.REFERRAL: d - 16 - I q COMPLETE & SUBMIT BY 115 /4 /0 <br /> DATE DATE <br /> ,./ <br /> ATTN: Kan�-/y�n m� -1 <br /> SITE ADDRESS: Il-1 `I l�o N l �I ( )a e p a c� L'-)A 1 <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: /KVi) Public sewage: �U <br /> SUMMARY OR COMMENTS: <br /> � pp <br /> 1 , D/3 J� " OeCav5e of flte 51.1rall ,5LLi4e l6/ parte / f/ <br /> rilef reSfi- icfi/on of fK evSPMenlS . 'TAe .5nR110/./ Qeo"nc <br /> 1/ A(rr - Tisa 06-41 ase 4n f/ VVla/�,,�h /Q �OnN Ni4Aw4N /;Z <br /> Th . S Zot Mau not 6e 6u '/ai„ g �n44 <br /> e vim} '.- ,' <br /> /l <br /> area { i3 ref iced fh41 as &ew �iuc°%Dmenf die leave..+ <br /> r l! - Pwl Ur 4n Cn ,n Cel�c� Se J�ic �fia n Ae --• <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: [/I� <br /> yfD Mit? aie x Q/oun 4l L✓4/�I^_ <br /> LAND USE CHECK OFF LIST: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: _Did you proofread the report? <br /> DID YOU USE THE CORRECT: <br /> _Land Use#? <br /> _Condition(s)#? <br /> Did you log it as completed? <br />