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.LAND USE REPORT APP#,.S/4 - 7 0/ — <br /> EI11)RECEIVED APP.REFERRAL: — COMPLETE & SUBMIT BY—J—,,2 —V9 <br /> DATE r <br /> / DATE <br /> ATTN: 111i / <br /> JU <br /> SITE ADDRESS: ' /e 9 9 et-• y"—"6N_ iealo.0 &t,, z) <br /> In completin. t Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water sul;. ^Pcessary, on an attached piece of plain paper_ draw completed map of area <br /> slh-)wing poi ition of house, wind direction, etc.... <br /> Public water: _ Public sewage: <br /> SUMMARY OR COMMENTS: <br /> C <br /> r <br /> I recommend: Approval Denial Continuance Inspector's Signaturq!:Zk 21nr� <br /> Supervisor/Lead Senior Comments: <br /> LAND USE CHECK OFF LIST: <br /> Did you proofread the report? <br /> SUPERVISOR/LEAD SENIOR APPROVAL: DIq YOU USE THE CORRECT: <br /> and Use#? <br /> Condition(s)#? <br /> #Did you log it as completed? <br />