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NOTE: PULL ALL,_.-ERMITS (Septic, Well, etc.) MAKL,.,,OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004994 -- <br /> DATE RECEIVED by EHD: April 19,2005 APPL#: PA-05-218 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2690 <br /> r J LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: ASA R , �1 a l © S <br /> BY, <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 13410 N LOWER SACRAMENTO RD, LODI APN : 05807006 <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: Approve enial Continuance Insp r: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA it Chaek Off List: Proofread Report? Correct LAND USE#? <br /> Correct-CONDITION(S)? Logged in LAND USE Book? <br /> EFT 06 06 Report#7201 Page 4 April 21,2005 <br />