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LAND USE REPORT APPA <br /> EHD RECEIVED APP.REFERR.-kL: —.),""/ 1 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: Luc) m A <br /> SITE ADDRESS: �;2 �G <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 /> ka <br /> cor <br /> II�A6 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Su eis /Lead Senior Comments: <br /> Tz.e <br /> 14 - Pp ,s <br /> u4-c i <br /> LAND USE CHECK OFF LIST: <br /> Did you proofread the report? <br /> DI YOU USE THE CORRECT: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: � andUse#? <br /> VPondition(s)#? <br /> �id you log it as completed? <br />