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Ar i' # �i 7 <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UrA _ ,,� �'� 9�� 'A ��22� ;�����-� <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSa) 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 /> SUMMARY OR OOMMFNTS: <br /> I. _ <br /> 2. <br /> 3- <br /> 4. <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 Q <br /> Y �tTW�tti, <br /> • <br /> Eli 06 06 3/71 <br />