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�JIIJU U5t'. 1{�'POI?T <br /> r <br /> APP N C <br /> To Be completed and Submitted by 'Z 1 �&j <br /> Date Issued <br /> ADDRESS UPA <br /> APPLICANT'S NAME ADDRESS <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 de4nsity, location of housed, wind direction, etc„ on an attached <br /> piece of plain paper. 1-1. .tet r 1 <br /> Size of Parcel L css —P u amu- Requirements sq. ft. <br /> Public Water (name) , c_ (t/` I/ Public Sewerage (name) <br /> SUMMARY.OR COMMENTS: <br /> ffjj� <br /> 2. <br /> J <br /> 3. <br /> On basis of above, I recommend: . Approval 17Denial <br /> �Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance <br /> Lill 06 06 3/71 11/83 500 <br />