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i L-in ;TQC ��F' 7T <br /> Ar # S 1/To Be completed and Submitted by �l0 <br /> y/�'�) Date Issued <br /> ro <br /> ADDRESS UPA c,�f7O V /� t"A.. L/c <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSED USE/CHANGE <br /> In completing the Land Us/6/ 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 Requirements sq. ft. <br /> Public Water (name) Public Sewerage (name) <br /> SUMMARY OR COMMENTS: n v <br /> 2. <br /> 3. <br /> L <br /> On basis of above, I recommend: Approval D[ey Continuance <br /> Signed <br /> FOR OFFICE USE ONLY <br /> Report to Planning Standard Paragraph Approval Disapproval Continuance Q <br /> oLAL A'�C, - <br /> EH 06 ob 3/71 <br /> � (� <br />