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i <br /> w LAND USE REPORT <br /> ! <br /> APPR <br /> 3b Be completed and Submitted by <br /> Date lasued <br /> ADDRESS UPA <br /> MYLICANT'S NAME ij' jr <br /> PROPOSED USE/CHANGE <br /> ADDY4:SS 2 /. i�,.�, <br /> In completing the Land Uae inv°atigation draw all Public Health factors an <br /> Savage diapoaal, nater supplies, etc. mere necessary, drayete° Mbit. <br /> of <br /> R �Oa abOwLng-Popu atiodr density, location of housed, widirsotioa, etc., a ma* <br /> pattached <br /> Piece of plain papend r. <br /> 51:o of Parcel Il Requirements aq. ft. <br /> Public Water (name) '--•-- <br /> Public Sewerage (name)SUMMA ---- -- <br /> Rr OR 004"M : <br /> 2. ! , <br /> On baaia of above,l� Y recoomiend: Approval . Denial Contimance <br /> Signed <br /> I, I� <br /> FUR OFFICE USE Or<LY <br /> Resort to Plaruif <br /> n8 Standard Paragraph Approval Disapproval Continuance 0 <br /> i <br /> alck <br /> 151 <br /> b, <br /> i <br /> II <br /> I Uk �. <br /> JA . C �v <br /> a, <br /> 06 06 3/71 1 <br /> 21/83 500 <br /> 6- <br /> Gb <br />