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• LAND USE REPORT <br /> f < . APP N Z_* <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA 13 C7 79 "T f CjGj tG y <br /> APPLICANT'S NAM /�Fa•t,6Ff,-� . c��� ADDRESS /3 '" ,f;y' J �:�`'%'� ,�•-& <br /> f , <br /> PROPOSED USE/CHAPIG� �`��,=�� �X � ��-=;�'`"��" .� �.,. �. 7777777, <br /> In completing the Land Uso investigation draw all Public Health factors on the exhibit. <br /> (i.e'.) Sewage disposal, water supplios, etc. here necessary, draw complete map of <br /> area showing population density, location of housed, wind direction, etc„ on an attached <br /> piece of plain paper. ��3 �e�F✓ <br /> Size of Parcel .�A���G �Z s;X1*e,'fKs Requirements sq., ft. <br /> Public Water (name)a- Public Sewerage (name) <br /> SUMMARY.OR 00MMENTS: <br /> 1. <br /> 2- <br /> 4. <br /> On basis or above, I recojumend Approval De"pial *-- Continuance <br /> Signed <br /> MR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance'. <br /> In the event that this application is approved, it i s requested <br /> that the following conditions be made a mart Of this approv_c1 . <br /> 1 . To be recorded on the Record of 'Survey: <br /> cq 2 ki <br /> If parcel, is ever sold an individual domestic <br /> water well , under a well Permit and inspection by <br /> the Environmental Health; Division , mu_,t be <br /> infstalled &ti P+vl* <br /> EH 06 <br />