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To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UYA <br /> APPLICANT'S NAME ADDRESS' <br /> PROPOSED USE/CHANGE <br /> In completing the Land Use investigation draw all Public Health factors on the exhibit. <br /> 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: <br /> 1. <br /> 2. <br /> 3. s <br /> 4. <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance Q <br /> -4 & ' e/( <br /> O " � <br /> EH 06 06 3/71 <br />