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LAND USE REPORT APP# <br /> k - - <br /> EIID RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY CtCj <br /> DATE DATE <br /> ATTN: KLCCS4 50di- 1� <br /> SITE ADDRESS: C���� <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 /> ,LS,2t, <br /> 4 Fr <br /> AO <br /> \,,-I* <br /> r <br /> I recommend: Approval Denial Continuance Inspector's Signa#ur�L /)Td�a-�-� <br /> iricir�aied::c�F�rk�r>exic�cic:'cxxxxx�ixxxxzF*iricxxxxxx�c�caE$icirirxir:exxieirkieie�ir�'e3rirxJe:F�c�<ie�Firirxx�Y�'eieie�iexiceFx�edcicvcicicis�f�'rir�c <br /> Supervisor/Lead Senior Comments: <br /> L�,}v S CHECK OFF LIST: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DP <br /> you proofread the report? <br /> �'' ° DIDl!YOU USE THE CORREC <br /> V�and Use#? - , <br /> VCondition(s)#? <br /> Did.you log it as completed <br />