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C DOTE: PULL AL! ERMITS (Septic, Well, etc.) MAK, OPIES FOR FALE <br /> LARD USE REPORT RECORD ID: S00006956 <br /> DATE RECEIVED by EHD: February 06,2008 APPL#: PA-0800004 <br /> Referral Agency STAFF CONTACT: JASON JONES PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE &SUBMIT BY: Wed, February 13, 2008 <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 Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance ❑ Inspector: <br /> Si nature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/ LEAD SENIOR Approval: date: <br /> OA it Check Off List. ��, rho ea ' ort? Correct LAND USE - <br /> Correct CO'3Di i 10N(S)7 v— � Dogged in LAND USE Boc.&? <br /> February 07,2008 <br />