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UND USE REPORT <br /> APPr <br /> To Se completed and Submitted by <br /> Date Issued <br /> ADDRESS UPS3 �/ � ..: <br /> A ,0LICUT'S NAME {f <br /> PROPOM USE/CHA.NGE AI)D Y <br /> . i) <br /> In completing the Land Use investigation draw all Public Health factors on the ea�ibit• <br /> (i•e:) 36vage disposal, water supplies, etc. W�tere necessary,, draw �l <br /> area shOwin8•POpulation, density, location of housed, wind direction, a c,,eoaTanpaLtached <br /> piece of plain paper. <br /> Size of Parcel <br /> Requirements eq. ft. <br /> Public Water (neons) Public Sewerage (name) •�- <br /> r, ..,p. — <br /> OR COMMTS: <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> 0 <br /> Report to Planning Standard Paragraph Approval � Disapproval Continuance <br /> S 3 � <br /> ,r <br /> �r <br /> Eli 06. 06 3/71 <br /> 11/83 500 <br /> t <br /> E ' <br />