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r <br /> NOTE: PULL AibOERMITS (Septic, Well, etc.) MAK!-::OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005243 <br /> DATE RECEIVED by EHD: July 25,2005 APPL#: PA-0500432 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE & SUBMIT BY: Tue, August 16, 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 10161 N JACK TONE RD,LODI APN : 06320003 <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 /> NaPurveyor N of stem <br /> SUMMARY 6R COMMENTS: <br /> � <br /> //`-�7�TP�//✓� .���.-yYn,��/ �� —`i�F// C.-Yi .�Ec.-rr..r�//)LY r'��rf ci,�' <=�r1�r�?r� <br /> ..ri+ <br /> •���✓ 4wG// l`�iiY//Y��/ /F?'ii�OS /2��""iYG/ rGS Pi��(¢!JO /L�/�. <br /> 1 A ommend1• Ap roval Denial ContinuanceEl <br /> Insp ctor: 7 <br /> Sign Lure <br /> Su isor/Lead Senior COMMENTS: <br /> la.�• D�G�i��/ ��-�S'fiLG�/i ,� ��/ i .��iroi�o� ���CG`�.���rfC lzF�i. <br /> ���"C> <� .d!✓ �c.-�zh' �P/Y//� �-TFY .�/oZ c'Q��,G .e�r��lC <br /> : 06 oti <br /> a, s -w- ✓ ✓ r/ t✓ <br /> � : 03 ✓ ✓ � <br /> 3 <br /> SUPERVISOR/ LEAD SEN R Approval: Date: <br /> OA 11 Check Off List: Proofread Report.' Correct LAND USE td ? <br /> Correct CONDITIONS)7 Logged in LAND USI', Book? <br /> o3a <br /> Ell 06 GG Report#7 01 July 26,2005 <br /> i <br /> h G- �S :d <br />