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-J11eb U 31', 1Cl',1'0ItJ <br /> APP 11 Il'IS �Sy -7b 15D <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA C� Lf 1 <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSED USE/CHANM <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 /> z <br /> 1. <br /> 2. / ' <br /> 3• ' <br /> On basis of above, I recommend: Approval enial Continuance <br /> Signed 2 <br /> � r' <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance <br /> 13 <br /> Ell 06 06 3/71 11/83 500 <br />