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nem nc:. a«cnum <br /> J ' 0 <br /> To Be completed and Submitted by <br /> Date Issued <br /> el <br /> ADDRESS UPA oC:. <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSED USE/CWiCSE <br /> In completing the Lard Use investigation draw all Public Health factors on the exhibit. <br /> (i.e.) Sewage disposal, water supplies, etc. Where necessary, draw complete map of <br /> area showing population density, location of housed, wird 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 OOMMENTS: D <br /> - <br /> 2. <br /> 3• <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed </ i41 <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval a Disapproval Continuance a <br /> L/ <br /> 3 o <br /> Eii o6 06 3/71 <br />