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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005843 <br /> DATE RECEIVED by ERD: December 27,2005 APPL#: PA-0300638 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2625 <br /> USE PERMIT-MINOR(UP) <br /> COMPLETE&SUBMIT BY: Wed, January 11, 2006 f <br /> Assigned to: EB0005366 MEDINA <br /> SITE ADDRESS: 16100 E HARNEY LN,LODI APN : 06504033 <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:�o� 5��.. <br /> -5 5215 <br /> i .fir Z2 <br /> I recommend: Approval Denial ❑ Continuance F-1 Inspe o <br /> Si ature <br /> Supervisor/Lead Senior COMMENTS: <br /> / - G:✓�� TQ�'t /OAC �cs.�„��' C.�°r'� �, ' <br /> 1Z14- <br /> �a• Q /rX3si' i i <br /> -Pre- iP--1[05 A 4, <br /> 206:02 ,vINrt-r4ee%�,� srlu� <br /> I NOTE: The Environmental:Health Department received•a, <br /> (Service Request#SR00q17(p7) on -/ , 2005 that has not been r&v4� 'Ar <br /> orov" <br /> r ; the report shall be reviewed and found acceptable by the Environmental <br /> Health Department. <br /> S <br /> SUPERVISOR/LEAD SENIOR Approval: Date: r ! <br /> OA Il Che Proofread Re o - 9 <br /> ck OAF List. P Correct LAND . <br /> �fiorrect CONDITIONS) -'-1gged-yin LAND USE Book? <br /> EH 06 06 Report 47201 December 28,2005 <br />