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NOTE: PULL AL.,dRMITS (Septic, Well, etc.) MAKL PIES FOR FILE <br /> LAND USE REPORT RECORD ID: 500008023 <br /> DATE RECEIVED by EHD: December 14,2009 APPL#: PA-0900294 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE & SUBMIT BY: <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: l 1769 N HWV 99 W FRTG RD, LODI APN : 05910010 <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 co> pMte`Map''Zf e s tion <br /> Aensity, location of house, wind direction, etc.... ", <br /> Public Water: yf Public Sewer: yy <br /> Name of Purveyor Name of System <br /> 11 <br /> 11:10 Submit a revised site plan or map to the Environmental Health Department <br /> showing sewage and well information that clearly delineates the sewage disposal <br /> location as required by ordinance requirements ( San .......... <br /> NOTE: 201:02 <br /> Applicant shall have the seepage pits and leach lines to the existing septic system <br /> (installed under permit # 84-655) uncovered to verify that the seepage pits and leach <br /> lines meet the required distance to the new property line according to the .......... <br /> O v-C lnnn <br /> PI RN ISOR i LEAD SENIOR Approval: Date: Z( L <br /> OA 11 Check Off List: Prooliead Report? Correct LAND 1 iSL'n ? <br /> (hm.t Cl)`a)f I ION(S)? Lodged in LAND USE nook? <br /> =11 lib 06 Rcponal'_nl <br />