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LAND USE REPORT C APP# - A, <br /> ~ EHD RECEINED APP.REFERRAL: q-IQ/ I 1 COMPLETE & SUBMIT BY Sfrlauj 9,q} <br /> DWE DATE <br /> ATTN: e4 , L)Q03A. <br /> SITE ADDRESS: _ o� 51 - ! 4 e <br /> e , 4n&L eel, <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 /> S <br /> I recommend: Approval Denial Continuance Inspector's Signature y! <br /> :eic:'ric:'sxic is is******�'cx****:49e*ir**dt e*c ve ie*******ie Tr ix**c it ie*xxic*x*****K6r ie****ic�c****dc**�tx�%ux*ie is 3cxiC�¢ir is <br /> Supervisor/Lead Senior Comments: <br /> LAND USE CHECK OFF LIST:. . <br /> SUPERVISOR/LEAD SENIOR APPROVAL: _Did you proofread the report? <br /> DID YOU USE THE CORRECT: <br /> _Land Use 4? <br /> _Condition(s)#? <br /> �• _Did you log it as completed? <br />