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Ak t1, <br /> L411 D USE REPORT <br /> APP ►ivy S — �. <br /> lb Be completed and Submitted by '3 3 �" <br /> Date Issued <br /> ADDRESS urA � Com% i <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSED USE/CHANGE <br /> In completing the Lard Use investigation draw all Public Health factors on the exhibit. <br /> Sevage disposal, water supplies, etc. Where necessary, draw complete ,map of <br /> area showing population density, location of housed, wird direotion, etc„ on an attached <br /> piece of plain paper. . <br /> Size of Parcel Requirements sq. ft. <br /> Public Water (name) Public Sewerage (name) <br /> SUMLRY OR OD*W TS: / <br /> 1. :F7: <br /> 2. <br /> 3. <br /> 4. <br /> On basis of above, I recommend: Approval —D1 Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval M Continuance a <br /> Eli 06 06 3/71 11/83 500 <br />