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4` ♦ om <br /> rt <br /> ND USE REPORT APP# 1( -� /�7ff Lxf� <br /> 0�0 — wf <br /> Elio RECEIVED APP.REFERRAL: 3':) COMPLETE & SUBMIT BY 3 � � 6 <br /> DATE DATE <br /> ATTN• <br /> fI �_ <br /> SITE ADDRESS: q 5 , S J`ri <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 /> 3-5 lYne.y I nx4 clanrnn6 4 CZ . a s c <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> is ie irkxx�cx�'e ie is it icxfrxie:'sxax�r 9r fr�Y'.c�c is kvE of Kds de 7k�r oee'exx�exxxxx�xirx�4�F 3e:Fxx�Y�Y 1r.Fxir se iez:e$4e�'e�e��r ak�k M�c�F�c 3e:F�c ie�e ec aF*x�'eXKx <br /> Supervisor/Lead Senior Comments: <br /> LAN9USE CHECK OFF LIST:j <br /> id you proofread the report? <br /> SUPERVISOR/LEAD SENIOR APPROVAL: Di✓YOU USE THE CORRECT: <br /> _Land Use#? <br /> 6/Londition(s)#? <br /> Did you log it as completed? <br /> E <br />