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` NOTE: PULL ALL _ RMITS (Septic, Well, etc.) MAKE,,�PIES FOR FILE <br /> LAND'USE REPORT RECORD ID: SU0004492 <br /> DATE RECEIVED by EHD: May 25,2004 APPL#: PA-04-273 <br /> Referral Agency STAFF CONTACT: JENNIFER JOLLEY PE : 2660 <br /> DEVIATION(D%) <br /> COMPLETE & SUBMIT BY: Tue, June 15, 2004 Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 12400 E KETTLEMAN LN, LODI APN : 06325002 <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 El Denial El Continuance ❑ Inspector: <br /> Signature <br /> Suoervisor/Lead Senior COMMENTS: <br /> ;VA 19 <br /> Q.4 <br /> SUPERVISOR/LEAD SENIOR Approval: Date: , PrA / <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 Page 1 June 03,2004 <br />