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--i <br /> rJ �. NOTE: PULL ALLN--CRMITS (Septic, Well, etc.) MAKE —JP1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004720 <br /> DATE RECEIVED by EHD: November 23,2004 APPL#: PA-04-692 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY:,.a0P � - � � <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 3355 W KINGDON RD, LODI APN : 05525005&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: %1�23Z <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial ❑ Continuance Insp <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: �d Y <br /> OA f!Check Off Llst . Proofread Report? f �Correct �ND3:S <br /> Correct CCINDITION(S ,?,ria fug'; - Loggect'in LAND USSR ook2w . <br /> 4 n. <br /> i <br /> EH 06 06 Report#7201 Page 6 November 24,2004 <br />