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LAND USE R l'OaT <br /> - APP # SL(i' ?7- S <br /> To Be completed and Submitted by 16- <br /> Date Issued <br /> ADDRi:SS Ui A <br /> Ail PLICAN T13 14AME 6S ADDRESS 7 <br /> PROPOSED USE/CHANGE 7)t l Ze E' <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 /> l. <br /> 2. <br /> 3• <br /> 4. <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed J1� <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance Q <br /> 01 <br /> f. <br /> 112- q �� <br /> EH 06 06 3/71 <br /> i <br />