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LA1dD USE Mt ORT P PZ" tl� <br /> APP # U - - doll-G <br /> To Be completed and Submitted by �2Ir/f? <br /> Date Iss11ued <br /> ADDRESS UPA 0 N <br /> APPLICANT'S NAME 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 C 7 ac yZ t Requirements sq. ft. <br /> Public Water (name) Public Sewerage (name) <br /> SUMMAR.Y.OR COMMENTS: <br /> 1. LO -Ls Q+its — S i Z 2—rl O AJ ,P A V— S Co2, <br /> 1 � I lJ �_ <br /> 2• yl h a)0 1e. 4-0 U ct I"I _ AJ '2 c - a �� Lt c,�+to_Ri <br /> 3• <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed (� <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance, <br /> � -�- <br /> cut) <br /> • <br /> EH 06 06 3/71 1 n I 11/83 500 <br /> 1 <br />