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NOTE: PULL ALL'PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005890 <br /> DATE RECEIVED by EHD: January 24,2006 APPL#: PA-0500841 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Wed, February 8, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 21400 N RAY RD, LODI APN : 01302027 28 29 <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 hLmp of S ste Z�� <br /> SUMMARY OR COMMENTS: �� <br /> Sle <br /> moo?• <br /> I ecq�ne d: Ap oval enial Continuance Insp <br /> � l iJ Sig ature <br /> SuyeryivisorlLead Senior COMMENTS: <br /> � o <br /> SUPERVISOR/LEAD SENIOR Approval: zv Date: Z 7 <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE# <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 January 24,2006 <br />