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NOTE: PULL ALL RMiTS (Septic, Well, etc.) MAKE OPIES FOR FILE <br /> RECORD ID: SU0004571 <br /> LAND USE REPORT <br /> DATE RECEIVED by EHD: July 20,2004 APPL#: PA-02-405 <br /> Referral Agency STAFF CONTACT: CHANDLER MARTIN PE : 2631 <br /> SITE APPROVAL-MINOR(SA) 1 <br /> COMPLETE& SUBMIT BY: Tue, August 3, 2004 <br /> Assigned toSE0000149 BORGES <br /> SITE ADDRESS: 13801 W ST RT 12 ,LODI APN : 02503004 <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 /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> r <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA!I Check ON List: .. Proofread Report? - Correct LAND tJSE#? <br /> Correct CONDITIONS)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 1 July 26,2004 <br />