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LAND USE REPORT APP# SA - M-J-9 <br /> -J-9 <br /> EHD RECEIN ED.-SPP.REFERRAL: / � COMPLETE & SUBMIT BY (o / <br /> DATE / ATE <br /> ATTN: J�-rT asks <br /> SITE ADDRESS: 11,2qO Fr-,eC1 rn <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 /> C) <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> it is ie ie:e ie ix icxexxic icxxic ie is is F eY ie*ie ie is icxicxic ie xic acxis k ie iexc it iexie ie><iexie cxxae*iexie iexie ie it kxiexirxix ie�e�e ie>ti iexie ie is:exit ie is:c:ex <br /> Supervisor/Lead Senior Comments: <br /> LAND USE CHECK OFF LIST: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: I Did You proofread the report? <br /> DD YOU USE THE CORRECT: <br /> _✓Land Use#? <br /> LI/Condition(s)#? <br /> bid you log it as completed? <br />