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LAND USE REPORT APP# <br /> 2> -;2COMPLETE & SUBMIT BY`I <br /> EIiI)RECEIVED APP.REFERRAL:T <br /> DATE n DATE <br /> ATTN: 1 f P-t` �� l <br /> SITE ADDRESS: <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 /> Ael <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Jrxir is�c ic:aic:e it ie kir ie it is�E vc dex*Ir ie 4r*ic drxir eF:kir*ic it it ie it it*ie is�:it it it 4r�Y*xir it ir:F�i�it nF k:F�e$ir is it vc it�F xeF 9c it it it is it it it�e kvFxxic�c�c ie is it ie <br /> Supervisor/Lead Senior Comments: <br /> LAIyD USE CHECKOFF LIST-- <br /> (/Did you proofread the report? <br /> SUPERVISOR/LEAD SENIOR APPROVAL: DYov USE THE CORRECT: <br /> and Use#? <br /> ondition(s)#? <br /> Did you log it as completed? <br />