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NOTE: PULL AL►,,.ERMITS (Septic, Well, etc.) MAKL.,MPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004649 <br /> DATE RECEIVED by EHD: September 28,2004 APPL#: PA-04-498 <br /> Referral Agency STAFF CONTACT: KEVIN SWANSON PE : 2626 <br /> USE PERMIT-GENERAL(UP) <br /> COMPLETE& SUBMIT BY: Wed, October 13, 2004 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 10967 N ST RT 99 W FRONTAGE RD,LODI APN : 05914037 <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 El Denial F-1 Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> 03 <br /> o <br /> �- FA-Z) C4" -+,off cb.e <br /> e ttawYt, <br /> C-.pt,.CO�LsrQ <br /> SUPERVISOR/LEAD SENIOR Approval: — Date: <br /> OA 11 Check.- :.Proofread Repo_ <br /> Correct CONDITION(S). <br /> EH 06 06 Report#7201 Page 6 September 30,2004 <br />