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" LAND USE- REPORT <br /> APP fM S 994" 7 <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA y Z� �c=' t T S�"e <br /> APPLICANT'S 14AME ADDRESS <br /> PROPOSED USE/CHANGE - <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 /> SUMiMY.OR COMM T51.1 <br /> 2. <br /> 3. <br /> 4. <br /> On basis of above, I recommend:.• Approval _� Denial _ Continuance <br /> Signed -�- � <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance'Q <br /> II . <br /> EH 06 06 3/71 11/83 500 <br />