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NOTE: PULL ALL P---n-.MITS (Septic, Well, etc.) MAKE C�-1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0006895 <br /> DATE RECEIVED by EHD: December 18,2007 APPL#: PA-0700554 <br /> Referral .Agency STAFF CONTACT: MO HATEF PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE& SUBMIT BY: Tue, January 8, 2008 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 15792 N RAY RD, LODI APN : 02514034 <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 /> ]rte <br /> I recommend: Approva enial ❑ Continuance F-1 Inspec <br /> Sign iture <br /> Supervisor/Lead Senior COMMENTS: <br /> F Ji ' 01 ` 2 ap-/' <br /> f'r ,'rL CCLV>t <br /> tied - hod ;vz- <br /> a <br /> v � Z <br /> F L5 ! 0 <br /> 2- <br /> e <br /> NtPERVISOR/ LEAD SENIOR Approval: Date: <br /> _ <br /> 'OA h Check Off List: Proofread Kc;:rt`? Correct LAND USE t#? <br /> Correct CONDITIOMS)? Logged in LAND USE-Book? <br /> =H 06 06 Report 47201 December 20,2007 <br />