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Lfi:dD USE P-"-pnaT <br /> ` <br /> AF i` # IS9-,fl?-9 <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UYA <br /> APPLICANT'S NAME <br /> 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• <br /> 4. <br /> On basis of a ve, I recommend: Approval DeniqI Continuance <br /> Signed �✓ � <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval M Disapproval Continuance Q <br /> 01POA 0 iwss 2oov a el DAA <br /> �n <br /> Cf/'(�U tl pf �",A rae� / Yy �r✓i slt �ial'�- �/�Li Dr►/ ���r0 / 61/ <br /> r✓-�'(�_ <br /> /gel- . <br /> EH 06 06 3/71 <br /> L/�. ✓1 i �ti/l�i�y p ° �I��/ Qh^ sij/ G /4'GL1r�i'L�t / //J'/t%1'►}y� G�/� � <br />