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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0011147 <br /> DATE RECEIVED by EHD: December 14,2016 APPL#: PA-1600258 <br /> Referral Agency STAFF CONTACT: JENNIFER JOLLEY PE : 2663 <br /> VARIANCE(VR) <br /> COMPLETE& SUBMIT BY: Wed, November 30, 2016 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 15467 E KETTLEMAN LN,LODI APN : 05308020 <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 /> SUPERVISOR/LEAD SENIOR Approval: Date: ( (� <br /> Il h k W7 Proo&ead Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 December 14,2016 <br />