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/ LAND USE REPORT <br /> APP <br /> TO Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UrA <br /> MY LICAN TIS NAME �"in, •, - , n <br /> 213 jl o 4z !&,�DRESS _ . CQ�� l r <br /> f'ROPOSED USE/CHANGE het 2 22 <br /> In completing the Land Uae lavestigation draw all Public Health fact-ora on the ej(hibit. <br /> Savage disposal, water auppliea, etc. <br /> area sbo dare aeceQaary, dray complete *map of <br /> �n8•population, denaity, location of houaed, wind direotioa, etc„ on an attached <br /> Place of plain paper. <br /> Size of Parcel �3 _V U Regairementa eq. ft. <br /> Public Water <br /> i (n ; A+ 015�red Public Sewerage (name) <br /> SUKUR1 OR (bf4ENT3:2. <br /> // <br /> re l/t r P l2 /cC �Qr9 tl+�l; SG`i�4 <br /> 3. , <br /> 4 <br /> On baela of above, I reco=end: Approval Denial Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance a <br /> ( a � 0 � -� . <br /> a� 0, <br /> El' ob ob 3/71 <br /> 11/83 S00 <br />