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NOTE: PULL ALL''�-•eRMITS (Septic, Well, etc.) MAKE L__AES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005111 <br /> DATE RECEIVED by EHD: June 20,2005 ADPL#: PA-0500336 <br /> Referral Agency STAFF CONTACT: RAYMOND HOO �, PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: ARRY. 64�7V <br /> ej Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: I0044`E HARNEY LN, LODI APN : 06308021,29,& <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 /> e of Purveyor ame of System <br /> SUMMARY OR COMMENTS:,�/d�' f Q e �--� <br /> (5)Ji <br /> CX <br /> I' <br /> I recommend: Approval; Den[al Continuance Ins ector: <br /> 'I �`C�j Si ture <br /> Supervisor/Lead Senior COMMENTS: � � �� 9-� <br /> i, <br /> .w <br /> 0 <br /> V L7r <br /> dL <br /> 'I <br /> l _ <br /> II <br /> I; <br /> �E <br /> i` <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> DA JI Gheck Off List: <br /> Proofread Report? �' Correct LAND USE#,? <br /> Coirect CONDITIONS)? Logged in LAND USE-13o60," :!,--,-11- <br /> Ell <br /> SE Book?Ell 06 06 Repon#7201 June 20,2( <br />