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^ i LAND USE REPORTrl <br /> '% <br /> APP — 30 :•. <br /> N <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA �� <br /> APPLICANT'S VAMC ADDRESS <br /> PROPOSED USE/CHANGE <br /> In completing the Land Use investigation draw all Public Health factors on the exhibit, <br /> (i.e',) Sewage disposal, water supplios, etc. -Were necessary, draw complete map of <br /> area showing population density, location of housed, winrl direction, otc„ on an attached <br /> Piece of plain paper. <br /> Size of Parcel Requirements sq. ft. <br /> Public Water (name) Public Sewerage (name) <br /> SUMMARY.OR OOMMENTS: <br /> 2. <br /> 4. <br /> On basis of above, I recommend:., Approval DGMAI Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance:Q .; <br /> EH 06 06 3/71 11/83 500 <br />