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Fit 1' <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UYA <br /> APPLICANT'S NAME ADDRESS <br /> ?ROPOS1-M USE/CHANGE <br /> e investigation draw all Public Health factors on the exhibit. <br /> In completing the Lard Us <br /> (i.e.) Sewage disposal, water supplies, etc. Where necessary, draw complete map of <br /> area showing population density, location of housed, wind direction, etcop 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 /> 1. - <br /> 2. <br /> 3. <br /> �• Approval Denial ntinuance <br /> On basis of above, I recommend: <br /> Signed "- <br /> FUR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval ContinuanceE--] <br /> /evH <br /> Y <br /> Eti oG oG 3/7i <br />