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i <br /> LAND USE REPORT APP#: L9 --q9-13 <br /> E <br /> HD RECEIN"ED.APP.REFERRAL: 3 -0-34� COMPLETE & SUBMIT IBy <br /> r DATE DATE <br /> f �� <br /> ATTN: i l:J"�" <br /> SITE ADDRESS: �� «' � -�mm�'`s <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 <br /> A-*,L tfA -r►E.kl75 M0 WEA.cS t luo -Sr'jruera lzt-s <br /> I recommend: ApprovalDenial Continuance ins`pector's Signature <br /> is is of do'e 'e iexic 9r".k'x�xx�X4s do is do 4e kvk is it do�Fx�e:F$e Jrxic>cxakxr.rxaF��t Lexie ir$k of kic��r ieki ac�c atixxlr ie do'ric$cKx:4 x�e k kvc do Y iF ae$ic it dcx9t is is <br /> Supervisor/Lead Senior Comments: I . <br /> i <br /> I� <br /> I� <br /> I� <br /> I� <br /> I� <br /> I <br /> LD USE CHECKOFF LIST: <br /> Did you proofread the report? <br /> SUPERVISOR/LEAD SENIOR APPROVAL: DID YOU USE THE CORRECT: <br /> V Land Use#? <br /> Condition(s)#? <br /> —Vpid you log it as completed? <br />