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NOTE: PULL ALL-FERMITS (Septic, Well, etc.) MAKE CIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005937 <br /> DATE RECEIVED by EHD: December 12,2006 APPL#: PA-0600066 REV <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, December 19, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 17142 N FOX RD, LODI APN : 05119024 <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 <br /> density, location of house, wind direction, etc.... <br /> Public Water: %%��� Public Sewer: �yy„ <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approv Denial ❑ Continuance Ins ector <br /> Sign ure <br /> Suoervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: <br /> iH 06 06 Report#7201 December 12,2006 <br />