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ADDRESS UPA W& <br />LAUD USE REPORT <br />APP # SZZ4`Z <br />`f ' <br />To Be completed and Submitted by 6 7 7 <br />T' <br />Date Issued <br />APeLICANT'S NAME (X w AUIJMZ)Z) <br />PHOPOSED USE/CHARGE <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 <br />Public Water (name)_ <br />SUMMARY OR COMMENTS <br />2 <br />3 <br />Requirements sq. ft. <br />Public Sewerage (name) <br />4. <br />On basis of above, I recommend: Approval _ Denial Continuance <br />Signed <br />FOR OFFICE USE ONLY <br />Report to Planning Standard Paragraph Approval L----lDisapproval p ContinuanceF/ <br />(J ✓`�^�'}f Vh V ' rte Ce <br />lei <br />y/ /J1 <br />EH o6 o6 3/71 11/83 500 <br />