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NOTE: PULL ALL fRMITS (Septic, Well, etc.) MAKL,,OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005701 <br /> DATE RECEIVED by E1ID: October 12,2005 APPL#: PA-0500585 <br /> Referral Agency STAFF CONTACT: CEALY LEIN �� PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Tue, November W,�ZoGj <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 13299 W ST RT 12 ,LODI APN : 02504003 <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: 9 Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS://1/ <br /> n� <br /> I recommend: Approva Denial ❑ Continuance ❑ In ecto <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date:. <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 October 17,2005 <br />