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i <br /> T .rn LTS� p_N_pnum <br /> {. At i' <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS U YA <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 complgte map of <br /> arra 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 /> U ✓ �, <br /> SUMMARY OR 00IrII�lEN TS: r Urw <br /> 1. ? <br /> ,2. <br /> G� �r <br /> �� � <br /> On basis of above, I recommend: Approval Denial Continuance <br /> .. :!s, )'' L,��S-�2 Signed :�— <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance Q <br /> EH o6 o6 3/71 <br />