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1AHL) U-br, 10,11ORT <br /> APP # �� �`1"g C Q y_ <br /> To Be completed and Submitted by <br /> ll Date Issued <br /> ADDRESS UPA �0�W O SSd& <br /> APPLICANT'S IJAlI 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 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 /> SUMMARY-OR COMMENTS: <br /> 1. AlItIX11-1 411 14 4/7 <br /> 2. f ; <br /> 3. <br /> On basis of above, I recommend: . Approval v Denial Continuance <br /> Signed <br /> 77 <br /> FOR OMCE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance; . <br /> � a f <br /> i;1i 06 06 3/71 � tQ/�i 11/83 500 <br /> t"� ', (/`/� ..� 2a~� N" /1� ac.►,« �^�,,•.vl lac co-G�c�✓v� <br />