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LAND UST-', R1,pORT <br /> 11q P. i <br /> APP <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA 1 �•t�c��d(, <br /> APPUCANT'S NAME ADDRESS <br /> PROPOSED USE/CHANCE . <br /> In completing the Land Uso invostiration draw all Public l{oalth tactors on the exhibit. <br /> �i•e'.) Sewage disposal, water supplio4 etc. necessary, <br /> of <br /> area showing population density, location of housed, wind di, eection, etc,,eon te unpattachod <br /> picco of plain paper. ' <br /> Size or Parcel Requirements sq. ft. <br /> Public Water (name) ' ' ' <br /> Public Sewerage (name) <br /> SUMMARY.OR COIdMI,;(TS: <br /> On basis of above., I recommend:., Approval _� Denial <br /> Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph -Approval Disapproval Continuance'. <br /> CC , <br /> EH 06 06 3/71 <br /> �\,�, 11/83 500 <br />