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V <br /> To Be completed and Submitted by <br /> Date Issued <br /> ADDRESS UPA �✓ �- <br /> APPLICANT'S NAME ADDRES <br /> ?ROPOSh-D USE/CWiGE <br /> In completing the Lard 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 shoring 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 OOMMENTS: <br /> 1. _ <br /> 2. <br /> 3• <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval disapproval Continuance a <br /> Eli 06 06 3/71 <br />