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NOTE: PULL ALL�'_,,RMITS (Septic, Well, etc.) MAKE�JIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004532 <br /> DATE RECEIVED by EHD: June 30,2004 APPL#:—PA-04-365 <br /> Referral Agency STAFF CONTACT: JENNIFER JOLLEY PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE& SUBMIT BY: Tue, July 20, 2004 Assigned to : HE0005366 MEDINA <br /> SITE ADDRESS: 23709 E BRANDT RD, LODI APN : 02317008 ' <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water <br /> supplies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population I <br /> density, location of house, wind direction, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> 44 <br /> / e <br /> l <br />}. 1 <br /> I recommend: Approval Denial ❑ Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: +� <br /> { <br /> Cl` dsh <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> Proofread Ite ort ' ' <br /> OA It Check'Off Lrst: P Correct LAND USE# <br /> Correct CONDITION(S) �o`gged"in LAND.LTSE„Book? <br /> EH 06 06 Report 47201 Page 8 July 07,2004 <br />