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T AAMD TTCW PTiPvUT <br /> APP # s <br /> To Be completed and Submitted by <br /> _ Date Issued <br /> ADDRESS UPA <br /> APPLICAhT'S NAME ADDRESS <br /> PROPOSED USE/CHAP;GE <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 complete 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 COMIENTS: <br /> 1. <br /> 2. <br /> 3• <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 b Disapproval Continuance Q <br /> �; ,�,� `1. �• ,rte �J 14e M t,� ,w / I S 8 7-lie <br /> �6 <br /> �(N1�LN�aHt atMv On FJ G�.r/ri.4�J- <br /> l�Q./L i" �c.Md D1t G��n /�"Y�"` /"'� _"' Q^"'d O� ���iV J� Oma• <br /> HH o6 o6 3/71 � <br /> �7 <br />