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APP // <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA 3 -7$ l-J - <br /> APPLICANT'S NAME DRESS <br /> PROPOSED USE/CHANGE <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. J y - <br /> Size of Parcel Requirements sq. ft. <br /> Public Water (name) Public Sewerage (name) <br /> SUMMARY.OR COMMENTS: <br /> 2. <br /> I� f <br /> 7 04P <br /> On basis of above, I recommend: . Approval Denial Continuance <br /> Signed 1•� ,2 <br /> s � <br /> FOR OFkaCE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance' <br /> l i:� 39 - <br /> • l � <br /> l:ti 06 061 1 <br /> 3/71 11/83 500 <br />