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j 1 <br /> NOTE: PULL ALC <br /> JERMITS (Septic, Well, etc.) MAK( PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0007744 <br /> DATE RECEIVED by EHD: May 29,2009 APPL#: PA-0900131 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2690 <br /> LOT LINE ADJUSTMENT(LA)COMPLETE&SUBMIT BY: , <br /> A R <br /> & IVI ILI Imf Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 11966 N FURRY RD, LODI APN : 06116002 25 26 <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: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Q Inspector: <br /> Supervisor/Lead Senior COMMENTS: Signature <br /> r � <br /> it <br /> SUPERVISOR/LEAD SENIOR <br /> Approval-ter <br /> Q.4 Itfiecl; r?fts7f <br /> R CorreL 4tat1J t3;E# <br /> . Proofread ort <br /> r : <br /> EH 06 06 Report 47201 <br /> May 29,2009 <br />