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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0009413 <br /> DATE RECEIVED by EHD: November 13,2012 APPL#: PA-1200192 RE <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE & SUBMIT BY: Thu, November 15, 2072 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 23623 N DE VRIES RD, LODI APN: 00304003 <br /> [n 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 <br /> 3ensity, location of house,wind direction, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> A) G i !a-u_CCAbrl 1c Sh(-*C AC awnwza2 4:<m ,15 5 xIift le�2s� <br /> I recommend: Approval a Denial Continuance El Inspect <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: _ Date: � z Z� /Z— <br /> OA 1/Check Off List: Proofread Report? Correct LAND IJSE# <br /> Correct CONDITION(S)? Logged in LAND tJSE Book? <br /> EH 0606 Report#7201 Aoremhei I� `r,l_ <br />