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To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UYA a � / e _✓`%���'/���� <br /> APPLICANT'S NAME DRESS <br /> ?ROPOSF-Z 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 <br /> area shoring 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 /> SUMARY OR COMI ENTS: <br /> 1. - <br /> 2. <br /> 3. <br /> 4. <br /> On basis of above, I reco=,end: ApprovalDenial Continuance <br /> Signed <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval [--1 Disapproval M Continuance Q <br /> c <br /> - ,�50 <br /> C*e- o'� <br /> sj- <br /> - , �;4 <br /> Eii o6 oG 3/71 <br />