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,A?71 rtc:: <br /> At V # as- ro <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA _ <br /> APPLICAfiT'S NAME "�.0 9'l� („s/JLPl/�S� ADDRESS <br /> PROPOSED USE/CHANGE ��/L •��[t- -�/ �IA�-�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, hind 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 CONSENTS: <br /> 1. <br /> 2. <br /> 3• <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 0 Disapproval Continuance Q <br /> EH 06 06 3/71 <br />