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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0011428 <br /> DATE RECEIVED by EHD: July 17,2017 APPL#: PA-1000071 <br /> Referral Agency STAFF CONTACT? ALISA GOULART PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, August 1, 2017 Tim' £>L4mjay1 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 11951 N JACK TONE RD, LODI APN : 06321015 <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 System <br /> SUMMARY OR COMMENTS: <br /> v 6 <br /> I recommend: Approval 9� Denial ❑ Continuance Inspector <br /> gnature <br /> Supervisor/Lead Senior COMMENTS: <br /> '-9 <br /> 6'a" w1, ek . <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 July 19,2017 <br />