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At V # s- $ —'5— <br /> To <br /> 'To Be completed and Submitted by 12 - 3/-8 <br /> Date Issued <br /> ADDRESS U YA <br /> APPLICANT'S NAME ADDRESS <br /> PROPOSED USE/CIW;GE <br /> In completing the Lard Use investigation draw all Public Health tactors on the exhibit. <br /> (i.e.) Sewage disposal, water supplies, etc. Where necessary, draw complgte map of <br /> area shoring population density, location of housed, gird 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: <br /> 1. <br /> 2. <br /> 3• <br /> 4. e <br /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FOR OFFICE USE ONLY <br /> Report to Flanning Standard Paragraph Approval M Disapproval Continuance <br /> 1 t— cllr <br /> Eii 06 06 3/71 <br />