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W <br /> / LA::D USL P-.P PT <br /> AFP #eSlI P-/916e <br /> rG� <br /> ` To Be completed and Submitted by —/ <br /> Date Issued <br /> ,'.ilDRFSS UYA <br /> APPLICANT'S NAME L' —If_P ADDRESS <br /> PROPOSED USE/CHAhCSv: <br /> In completing the Land Use investigation draw all � lic Healt 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 ODMKENTS: <br /> 2. <br /> 3. <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval a Disapproval Continuance Q <br /> A'tg <br /> y/ 6627 <br /> EH 06 06 3/71 <br />