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Ai 1' !/ O �G <br /> To Be completed and Submitted by <br /> ,D/ate Issued_ <br /> ADDRESS U f-A <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSE) USE/CWiC.E <br /> In completing the Land Use investigation draw all Public Health factors on the exhibit. <br /> IInco Sewage disposal, water supplies, etc. Where necessary; draw complete 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 /> SUMARY OR OD2 I ENTS: <br /> 1. - <br /> 2. <br /> 3- <br /> 14- <br /> On <br /> .4.On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FOR OFFICE USE ONLY f <br /> Report to PlanningStandard Paragraph Approval Disapproval, Continuance Q <br /> Q � <br /> C <br /> Eii 06 06 3/71 <br />