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' ll) <br /> LAND USE REPORT <br /> APP <br /> TO Be completed and Submitted by <br /> F <br /> Date Issued <br /> ADDRESS U1~A <br /> iv � - <br /> AP?LICANTIS <br /> NAME tr- <br /> .i � I ADDRESS _, .1 . <br /> PROPOSED USE/(WGEr,C, c1 <br /> In completing the Lard Uae iaveatigation draw all Public Health factors on the edxibit. <br /> SeVage disposal, valet supplies, etc, <br /> 4" of <br /> & ahOwing•Population- density, location of housed,are nwirds3ary, draw direotion, attc ,eon mianpattached <br /> Piece of plain paper. <br /> Sire of Parcel Regairementa eq, ft. <br /> ---------------- <br /> Public Water (name) Public Sewerage (name) <br /> SUMARZ OR COM) ?(T5: -T <br /> V <br /> l ► - <br /> z � <br /> On basis of aboveo <br /> I reco=end: Approval Denial Continuance <br /> Signed <br /> FUR OFFICE USE Ot.LT <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance a <br /> I sO <br /> ISO — 68 <br /> Eh 06 ob )/71 V k,-, t� C• G � <br /> 11/83 500 <br /> J `� <br />