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r l.' LAND US'/I�E 'PORT 3Y4 �y <br /> fly o a —6/5 '77 7 <br /> t` APP N 5R — <br /> 4 <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS urn / 3 ,1� <br /> APPLICANT'S 14AME J <br /> ADDRESS,` <br /> PROPOSED USE/CHIUICS <br /> In completing the Lard Use investigation draw all Public Health factors on the exhibit. <br /> (i.e.) Sewage disposal, water supplios, etc. Nhero necessary, draw complete map of <br /> area showing population density, location of housed, wind direction, etc,, on an attached <br /> Piece of plain paper. <br /> Size of Parcel /�6���f�i Requirements sq. ft. <br /> Public Water (namo),,ir Public Sewerage (name) <br /> SUMMARY.OR COMMENTS: <br /> On basis of above, I recommend:., Approval De al Continuance _ <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance' q <br /> Ell o6 06 3/71 11/83 500 <br />