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� 1.) <br />-T A7�-n TUTS as Nn1�T <br />To Be completed and Submitted by <br />Date issued <br />ADDRESS UYA'�� <br />APPLICANT'S NAME � ��� � , � �' ADDRESS <br />PROPOSED USE/CHANCE <br />In completing the Lard Use inve6tigation 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 OOMMENTS: <br />1 • v <br />2. — <br />3. <br />4. --- <br />On basis of above, I recommend: Approval Denial Continuance <br />Signed <br />FOR OFFICE USE ONLY <br />Report to Planning Standard Paragraph Approval 0 Disapproval n Continuance Q <br />Ex o6 o6 3/71 �� <br />