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T nr•tn ttc a�t na r <br /> ` AF? # / y/ `PD v01 <br /> To Be completed and Submitted by <br /> /f Date Issued <br /> ADDRESS UYA <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSED USE/CHA.NGE <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. <br /> 3• <br /> 4. <br /> On basis of above, I recommend: Approval V Denial Continuance <br /> Signed �\\ <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval [2Disapproval Continuance Q <br /> �� - <br /> EH 06 06 3/71 <br />