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LAND USE MPORT <br /> APP # <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA .� 6)APPLICANT'S NAME'+42!f' .,� ADDRESS��6i7'1 �1.1�.P�/oal.1"1 <br /> PROPOSED USE/CHAl1GE,,e/ 0 g <br /> o1.r •f f'.�,: '•- <br /> In completing the Land �seinvnSes igat oo, d,raw 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 ojC housed, wind direction, etc„ on an attached <br /> piece of plain paper. a 9�aF y-K�,f� %�✓P6��v F'x�Jf•�✓6�4e.,���s/ . ,��F <br /> 'Z �09C,(F ye Fr�le /ylLVOFJ C�Y�t�i-✓ff9�fi.l .�e�f/%FA '�<d/�CF� G/�'.. 0+9� <br /> Size of Parcel . .�'.� ,f�cJ .a,'ab Requirements sq, ft. <br /> Public Water (name�y.,/F,d'e/ Sewerage (name),&�ter4'1 /opt ��✓�� � � <br /> SUMMARY.OR COMMENTS: <br /> 3• <br /> 4. <br /> On basis of above, I recommend:.. Approval :Denial Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph -Approval Disapproval Continuance' [:] .' <br /> r 1 <br /> EH 06 06 3/71 11/83 500 <br />