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rnrm nc- a;;,pnam <br /> 1 � <br /> l 7 At P # Ors <br /> To Be completed and Submitted by d 7 <br /> Date Issued <br /> ADDRESS UPA n D <br /> APPLICANT'S NAME .� L 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 complgte'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 /> SUMARY OR OOIMNTS: <br /> 2. <br /> ���' !�!� " n'i„' z ''�,f' tea,; 1►� t `y'� <br /> 3• <br /> 4. <br /> On basis of above, I recommend: Approval Del Continuance <br /> Signed <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph ApprovalKDisapproval L�] Continuance Q <br /> . � � .. <br /> EH 06 06 3/71 <br />