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Y <br /> ' LAND USE REPORT APP# <br /> j COMPLETE & SUBMIT BY /� �3 <br /> he9EI-ID RECEIVED.SPP.REFERRAL: <br /> DATE DATE <br /> ATTN: J,!Yi 160 6uretq <br /> SITE ADDRESS: -ri-AA <br /> his -- <br /> In completing th�d 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 /> Nq <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> } <br /> LA D USE CHECK OFF LIST: <br /> SUPERVISORILEAD SENIOR APPROVAL: Did you proofread the report? <br /> ._-. DID YOU USE THE CORRECT: <br /> 1 Land Use#? <br /> 1ondition(s)#? <br /> Did you log it as completed? <br />