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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> AND USE REPORT RECORD ID: S00005076 <br /> DATE RECEIVED by EHD: May 31,2005 APPL#: PA-0200086 TE <br /> Referral Agency STAFF CONTACT: KARLA KUHL PE : 2622 <br /> SUBDIVISON-MINOR(NIS) <br /> COMPLETE & SUBMIT BY: Tue, June 21, 2005 <br /> Assigned to : EE0000149 GORGES <br /> SITE ADDRESS: 21461 E KETTLEMAN LN, LODI APN : 05355003 <br /> J completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water <br /> applies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of arca showing population <br /> ensity, location of house, wind direction, etc.... <br /> 'ublic Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> UMMARY OR COMMENTS: <br /> recommend: Approval ❑ Denial F-1 Continuance El Inspector: <br /> Signature <br /> supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR i LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE# - <br /> Correct CONDITION(S)? :. Logged in LAND USE Book? <br /> 3H 06 06 Report 47-'t-I June 01,2005 <br />