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LAND USE R1-,PORT <br /> ` APP # <br /> To Be completed and Submitted by <br /> /����� /► fC Date Issued <br /> ��. <br /> 11 <br /> ADDRESS UPA <br /> APPLICANT'S I4AME F ADDRESS <br /> PROPOSED USE/CHMIGE <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 COMMENTS: <br /> 2. or 024L 1,-jeZZ ape 77 <br /> A. z � r � <br /> On basis of above, I recommend: Approval ✓ Denial Continuance 5c-ov f� C <br /> i-5 C,r Gf S 5c ,,�. <br /> Signed " c� 42,2 re•..�� <br /> .. <br /> Z 9 <br /> FOR OFFICE -TSE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance. <br /> EH o6 o6 3/71 11/£33 500 <br /> Y/ 700r <br />