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r ATM ncz:. :Jr Gn:JT <br /> ATP # <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UFA <br /> APPLICANT'S NAME <� �/ ADDRESS <br /> PROPOSED USE/CHAN 1i1/�r5 ��� i1/�'�•e:� vt - <br /> In completing the Land Use investigation draw all Public Health factors on the exhibit. <br /> (i.e.) Sewage disposal, water supplies, etc. Where necessary, draw comp lgte 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 Requirements sq. ft. <br /> Public Water (name) Public Sewerage (name) <br /> SUMMARY OR CO1MTS: <br /> 1. <br /> 2. <br /> 3• <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval 0 Disapproval M Continuance Q <br /> 3�lk GaLg <br /> EH 06 06 3/71 <br />