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NOTE: PULL ALI.wsRMITS (Septic, Well, etc.) MAKE,%..JPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004491 <br /> DATE RECEIVED by ERD: May 25,2004 APPL#: PA-04-268„/ <br /> Referral Agency STAFF CONTACT: JENNIFER JOLLEY PE : 2626 <br /> USE PERMIT-GENERAL(UP) <br /> COMPLETE& SUBMIT BY: Wed, June 16, 2004 Assigned to : EEOOOO149 BORGES <br /> SITE ADDRESS: 12098 N WEST LN,LODI APN: 05811040 <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: / cif � P�j�y j <br /> I recommend: Approval Denial F-1 Continuance Inspector: <br /> Sign tre <br /> Supervisor/Lead Senior COMMENTS: 6)a <br /> �. . �� <br /> �a' U Z-0- s e2 <br /> .� <br /> 38th9-boat <br /> SUPERVISOR/LEAD SENIOR Approval: - '�� "� Date: ' <br /> OA 11 Check OH List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USG Rook? <br /> ;111 06 06 Report(,7201 Page 4 June 01,2004 <br /> Y <br />