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r nr�n rTc:: a�anum <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UYA <br /> APPLICANT'S NAME AE DRESS <br /> PRIOPOSM USE/CHA.NGE <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 /> 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 /> SUMARY OR OOMMENTS: <br /> 2. <br /> 3• <br /> 4. <br /> On basis of above, I recommend: Approval Deniia Continuance <br /> Signed `", <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval n Disapproval M Continuance Q <br /> c� <br /> EH 06 06 3/71 <br />