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LAND USE REPORT <br /> APP <br /> To Be completed and Submitted by Z <br /> Date Issued <br /> ADDRESS UPA _ f 3 c7 7" AA <br /> APPLICANTIS 14AME �Fc.f6el�i. ; c�f9L ADDRESS �1 / �% �• '` <br /> PROPOSED USE/CHANGE G%',;'��• •` �� l �"''''��'� - <br /> In completing the Lard Use investigation draw all Public Health factors on the exhibit. <br /> (i.e'.) Sewage disposal, water supplios, etc. Where necessary, draw complete map of <br /> area showing population density, location of housed, wird direction, otc„ on an attached <br /> piece of plain paper. -e, <br /> Size of Parcel ���«� z s%����«� Requirements sq.. ft. <br /> Public Water (name). " �� /� ' Public Sewerage (name) ,% <br /> SUMMARY-OR 00MMENTS: ... <br /> 2. <br /> 4. <br /> On basis of above, I recommend:., Approval Depial Continuance <br /> Signed- <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph -Approval Disapproval Continuance:[� •i: <br /> In the event that this application is approved, it i,-1 reque-eted <br /> that the following conditions be made a part of this approval . <br /> 1 . To be recorded on the Record of :purvey : <br /> 1 01. � lS <br /> If parcel ft is ever sold an individual dorm,-stic <br /> water well , under it well permit and in-speotion by <br /> the Environmental Health Division , must be <br /> instolle.d v►�j �O�r�l A <br /> EH 06 i <br />