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1.11140 U66 10"PORT <br /> • ; <br /> ..� APP <br /> To Be completed and Submitted by <br /> / G Date Issued <br /> ADDRESS UPA <br /> APPLICANT'S NAIM ADDRESS <br /> PROPOSED USE/CHA1jGE <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 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) pl t ►Ja Z 1( Public Sewerage sCr( <br /> (name) p,s 1 r Sd-o C , 40 0 <br /> SUMMARY-OR COMMENTS: <br /> 2. a e_ b� �t <br /> 3 <br /> c s v� e V1_ <br /> Z/ <br /> On basis of above, I recommend: . Approval 'Denial Continuance <br /> C f' Signed <br /> FOR OFPZCE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance; <br /> G- V� �. <br /> EH 06 06 3i 71 d/83 500 <br />