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r;M <br /> LAND USE REPORT `' APP# �''Sf} -�j -47 6,c1t,„s;nn <br /> EHD RECEIVED.SPP.REFERRAL: 3/-73M COMPLETE & SUBMIT BY J45A P <br /> DATE DATE <br /> ATTN: —)Q ms's' he r <br /> SITE ADDRESS: aZ 0 00 5 .ro,JS st 'A Q*-�noe- , 'rr�►r,.. <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *icx�e�k ec is�c*4r 4r ie is of oY�k*acxde3e�'e it is de ie�r�e{r�Y$ir it ie�t sic 3e*xx9e is ie oie nlr$c�e�e�kknX�rx�F 9r�Ie sic dr*ie�e E�'c ie it ixlcxie Tr ie iexie is icxie*�e:vie ie�c�exF ie <br /> Supervisor/Lead Senior Comments: <br /> LAND USE CHECK OFF LIST: <br /> VDid you proofread the report? <br /> SUPERVISOR/LEAD SENIOR APPROVAL: DID YOU USE THE CORRECT: <br /> L/ and Use V <br /> ndition(s)#? <br /> Did you log it as completed? <br />