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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005832 <br /> DATE RECEIVED by EHD: December 20,2005 APPL#: PA-0500804 Pre-Application <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2626 <br /> USE PERMIT-GENERAL(UP) <br /> COMPLETE& SUBMIT BY: ; @r December 28, ap&Wftl- <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 9301 W HWY 12 , LODI APN : 02508002 <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: 1-7-2 _,� Public Sewer: <br /> Name of Pury yor Name of System <br /> SUMMARY OR COMMENTS: <br /> r• <br /> ��'l'�i/ l/�a!%�i✓cam (�9-�0.f� ���/r_.r2'Y/ <br /> �v <br /> I recommend: Approval Denial Continuance Inspe tor• ��� �« <br /> Sign tore <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: c_ Date: / d <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 December 21,2005 <br />