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LAND USE REPORT &A-))Joj <br /> t EHD RECEIN ED APP.REFERRAL: 3.9 -9q COMPLETE & SUBMIT BY -qq <br /> DATE DATE <br /> ATTN: — –n M An() r b <br /> SITE ADDRESS: ) C"SD (-A � ImCLp(1Gi(Q 12 C] . . S � K <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: ( I <br /> 7E 6�I visew.l.v6.l r�ye �s'Ee«/ +d rVis.o Al rG4s �� co K/.rio tl S Ty <br /> r�•�os� CPA -�l�s A4d1=6v4-77C J <br /> I recommend: Approval Denial Co Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> LAND USE CHECK OFF LIST: <br /> Did you proofread the report? <br /> SUPERVISOR/LEAD SENIOR APPROVAL: DI You USE THE CORRECT: <br /> V ad Use#? <br /> _ ondition(s)#? <br /> id you log it as completed? <br />