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NOTE: PULL ALL L--watMITS (Septic, Well, etc.) MAKE L—APIES FOR FILE <br /> LAND USE RtPORT RECORD ID: SU0004656 <br /> DATE RECEIVED by EHD: October 07,2004 APPL#: PA-03-99(TE) <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, November 2, 2004 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 2320 W SARGENT RD, LODI APN : 02517005 <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 F� Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: sh;' < Date: <br /> OA 11 Check Off List: Proofread Report? 71.ogged <br /> Correct LAND USE#? <br /> Correct CONDITION(S)? in LAND USE Book? <br /> EH 06 06 Report#7201 Page 4 October 08,2004 <br />