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(1.) <br /> T nrrn TiC� A�P(l aT <br /> AF? # <br /> h G r� <br /> To Be completed and Submitted by �' �/-J / <br /> Date Issued <br /> ADDRESS UFA ' C �� <br /> APPLICANT'S NAME�i �L-��� %'• ADDRESS <br /> PROPOSED USE/CHANGE =2LV 2- Z" <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 complgte'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 COMMENTS: / f <br /> 1. na/1' ��`' <br /> 2. <br /> 3• <br /> 4. <br /> On basis of above, I recommend: Approval ni. 1 Continuance <br /> Signed All <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance Q <br /> CC <br /> 41c_�t.� yv� <br /> • <br /> HH 06 0 3 <br />