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i <br /> LM <br /> NOTE: PULL ALL PERSh-tS (SEPTIC, WELL, ETC... 'WAKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-04-95 (LA) <br /> EHD RECEIVED APP.REFERRAL: -3/10104 COMPLETE & SUBMIT BY.. *ASJP—BY M S/D_ 4_ <br /> DATE DATE <br /> ATTN: RICK GRIFFIN <br /> SITE ADDRESS: 3475 WEST SARGENT ROAD LODI <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw a completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: /ht7 <br /> SUMMARY OR COMMENTS: <br /> Z/ <br /> I'recommend: Approval Denial Continuance Inspector's Si ure <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL <br /> EH 06 06 Rev 1149 ' [7Q1 L'fi T4'flttl Y�tl @fits <br />