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NOTE: PULL ALL-.,--'RMITS (Septic, Well, etc.) MAKtc-. JPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004823 <br /> DATE RECEIVED by EHD: February 08,2005 APPL#: PA-05-43 <br /> Referral Agency STAFF CONTACT: AN M V192MCPE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE & SUBMIT BY: s' � ' fS <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 16475 N LOCUST TREE RD, LODI APN : 05117018& <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 Ins ctor: Y <br /> Sign tare <br />` Supervisor/Lead Senior COMMENTS: <br /> 76 <br /> ar <br /> N Z-/- <br /> SUPERVISOR/ <br /> -SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA II Check Off List: Proofread Report? Correct LAND USE 4? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> Z <br /> EH 06 06 Report 47201 Page 4 February 10,2005 <br />