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4-a 11 <br /> ° LAND USI", REPORT <br /> ' �G Fe <br /> �. APP N — <br /> • To Be completed and Submitted by <br /> Data Issued <br /> ADDRESS UPA •. G ( r <br /> APPLICANT'S NAME o ADDRCSS <br /> PROPOSED USE/CHANGE� <br /> In completing the Lary; s&inveJa �ation draw all Public Health factors on the exhibit. <br /> (1.0.) Sewage disposal, water suppliou, etc. Where necessary, draw complete map of <br /> area showing population donsity, location of housed, wind direction, etc„ on an attached <br /> picco of plain paper. <br /> Size of Parcel Requirements sq. ft. <br /> Public Water (name) Public Sewerage (name) <br /> SUM1MY,OR COMMENTS: ' <br /> 2. <br /> On basin or above, I recommend:., Approval Denial Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard paragraph ApprovalDisapproval Continuance,Q <br /> " •moi• <br /> EH 06 06 3/71 11/83 500 <br />