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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0010056 <br /> DATE RECEIVED by EHD: May 02,2014 APPL#: PA-1100024 <br /> Referral Agency STAFF CONTACT: STEPHANIE STOWERS PE : 2656 <br /> REVISIONS TO ACTIONS(RA) <br /> COMPLETE &SUBMIT BY: Tue, May 20, 2014 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 18667 N JACOB BRACK RD, LODI APN: 01109003 14 01115012 23 <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: <br /> I recommend: Approval ❑ Denial ❑ Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> St FERN NOR LLAD SILNIOR Approval: Date: <br /> OA 11 Check OH List: Proofread Report? Correct LAND USE k? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> Elt 06 06 Report 47201 <br />