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LAND USE REPORT APP# a -C 7 <br /> • EHD RECEIVED APP.REFERRAL: o-16 r ! COMPLETE & SUBMIT BY � <br /> DATE DATE <br /> ATTN: Te-Cc sn f�ix C i C <br /> SITE ADDRESS: Wen (&1 � QST 9� �— � � ,� (4, j <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: LZ 6) Public sewage: A/i> <br /> SUMMARY OR COMMENTS: <br /> 0 <br /> l { - 0 N r� (i✓Q <br /> 1 i re��rA ti W lVe� <br /> ['7 l ae n r7 e, f'd' S �1 /) <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 'I[JCX�C�CXXX7C 7�C�[�C 7�f XJC 7ti'IC'IC9[�Y]�C�C�C)C)C 7CX]1C]FX1CX7[�C�F)Ci•C]�G�C�C]fC 7f 1CXX]C]E'J[9F]K]FXY:C:C:CxJC:C>C:C:f:CYTfX:c;[:f:t:c x;CXX7C 7FX1FXXY::::YX:C:C:C 1C <br /> Supervisor/Lead Senior Comments: <br /> el/f <br /> LAND USE CHECK OFF LIST: <br /> Did you proofread the report? <br /> SUPERVISORILEAD SENIOR APPROVAL: DID YOU USE THE CORRECT: <br /> Land Use#? <br /> _ ondition(s)#? <br /> Did you log it as completed? <br />