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7 h!'fl US a-?Q!. T <br /> AF i' # <br /> To Be completed and Submitted by —\ `2, <br /> (IDate Issued <br /> ADDRESS UYA �1 �`� k C� 7 l I c:Ir� <br /> APPLICANT'S NAME ADDRESS <br /> ?ROPOSED USE/CHANGE <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, wird 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 /> On basis of above, I recommend: Approval Denial Continuance <br /> Signed <br /> FUR OFFICE USE ONLY <br /> Report to Flanning Standard Paragraph Approval Disapproval Continuance a <br /> l� <br /> EH 06 06 3/71 <br />