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I.J040 UJr, <br /> S <br /> v�v"\ APP # <br /> To Be completed and Submitted by o� <br /> Date' Issued <br /> ADDRESS UPA <br /> APPLICANT'S NAIIE ADDRESS <br /> PROPOSED USE/CHANCE <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 complete 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 /> SUMMARY-OR. COMMENTS: <br /> 2. ,c`s <br /> 3• <br /> On basis of above, I recommend Approval , ---De al Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance <br /> Iii 06 06 3/71 11/83 500 <br />