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NOTE: PULL ALL*r,.RMITS (Septic, Well, etc.) MAKE "PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005821 <br /> DATE RECEIVED by EHD: December 13,2005 APPL#: PA-0300064 TE <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2690 <br /> AgA ` LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: . CIU <br /> Assigned to : EE0009649 ESTRADA <br /> SITE ADDRESS: 14444 N RAY RD, LODI APN : 05517021,22 & <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 F-1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> K7 z-1- <br /> SUPERVISOR/LEAD SENIOR Approval:. r Date: <br /> 71 <br /> OA It Check Off List: Proofread Reportr Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 December 14.2011 <br />