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z <br /> 1 <br /> NOTE: PULL ALL_,ARMITS (Septic, Well, etc.) MAKE JPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004585 <br /> DATE RECEIVED by EHD: July 22,2004 APPL#: PA-04-367 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2690 <br /> lAiW—by: � '� � LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT B <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 14239 E SARGENT RD,LODI APN : 05303014&54 <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 /> coo <br /> q� <br /> r R <br /> I recommend: Approval F-1 Denial ❑ Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 1!Check Off List Proofread Rego? Correct LAND USE#7 <br /> Correct CONDITIONS) ?' , _ Logggd ift:LAND USE Book? <br /> EH 06 06 Report#7201 Page 10 July 27,2004 <br />