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Ai'i' ri 7;?- Y-- 2-C) <br /> To Be completed and Submitted by -7 <br /> Date Issued <br /> ADDRESS UFA �' s' a- <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSE USE/QWiGE <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 complte map of <br /> area showing population density, location of housed, wird 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 OOMMENTS: <br /> 1. <br /> 2. <br /> 3- <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 0 Continuance a <br /> /. -_j '4'3. �„ - <br /> t::H ob Ob 3/71 <br /> A OAA <br /> �� <br />