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NOTE: PULL. Alafp�E'RMITS (Septic, Well, etc.) MAKE G-thIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0008175 <br /> DATE RECEIVED by EHD: April 01,2010 ADPL#. PA-1000071 <br /> Referral Agency STAFF CONTACT: CORRINE KING PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE& SUBMIT BY:I<Tue, April 20, 2010 <br /> Assigned to : EE0005366 MEDiNA <br /> SITE ADDRESS: 11951 N JACK TONE RD, LODI APN : 06321015, 16 <br /> .n 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 /> tensity, location of house, wind direction, etc.... <br /> Public Water: ��� Public Sewer: fav <br /> ((�� Name of Purveyor Name of System <br /> ;UOIMARY OR COMMENTS: <br /> Al <br /> ate, <br /> recommend: Approval Denial Continuance Ins ector: <br /> Sig afore <br /> ;unervisor/Lead Senior COMMENTS: <br /> ,UPERVISOR 1 LEAD SENIOR Approval: Date: <br /> OA I!Check Off Ciaf " Pro6freadI>port? �° � x Correct LAND <br /> o ed'in LAIC LTSE I3ook� "' <br /> r Correct CONI'ITION(S}? <br /> H 06 06 Report 97201 April 02,2010 <br />