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LAND USE REPORT APP#_ �� j - -C)7 <br /> EHD RECEIVED.APP.REFERRAL: • COMPLETE & SUBMIT BY U/ 6-1q C <br /> DAT <br /> ATTN: , LdoMa <br /> SITE ADDRESS: 12 4--• oZ�o <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 ORCOMMENTS: <br /> a't: ►/ori - <br /> GL � <br /> 3- !✓ELL 6 nG4 rX;C� AA1 SAG 'ry -av P• 1 <br /> 5A� ,A6-AY-i la&!5 S-� oil s 1-rF_ <br /> 1GF4dnLrt[wn 7 a0F�i-7,05 #0 w, S Y!5 r36--a-7 <br /> P* -\-A/02 -oti cgoE gj -r toPte <br /> sC -rr oA 6(o262 •-A <br /> A� <br /> Pc f c�2 . :O ALL Art s rA vtWAS-4- <br /> -4 <br /> < O� � GGiDE'. G P •s~+9 G GQ.W67 �Ct�►D+� ..J <br /> I recommend: Approval_c� Denial ontinuance Inspector's Signature at►d)2r - 3wv <br /> ltXXXXX:C]C]C][XX)CX:t JC iCXXX�CltX�t�C 7F)CXXXXXXXXXXfCX%!C%XXif]fiC:ti[iC%:��cXXXXat X:CXXxx]CXXXx XlC �x XIt 7�'txx *7•C 7C deXie is 9c <br /> Supervisor/Lead Senior Comments: <br /> L Ltj <br /> LAND USE CHECK OFF LIST: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: _ZDid you proofread the report?DID YOU USE THE CORRECT: <br /> hand Use#? <br /> Condition(s)#? <br /> Did you log it as completed? <br />