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NOTE: PULL AL*—.-+ERMITS (Septic, Well, etc.) MAKL-COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004753 <br /> DATE RECEIVED by EHD: December 21,2004 APPL#: PA-04-756 <br /> Referral Agency STAFF CONTACT: GILLIAN HAYES PE : 2625 <br /> COMPLETE& SUBMIT BY: USE PERMIT-MINOR(UP)� . � �(�5 <br /> Assigned to : EE0009374 GODINHO <br /> SITE ADDRESS: 23243 N ROND RD, LODI APN : 01105008 <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 /> oe <br /> Aw— <br /> I recommend: Approval Denial Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> fj� c <br /> k v 3_ <br /> too,- <br /> L.,►•► <br /> y ". <br /> SUPERVISOR/LEAD SENIOR Approval: te• >✓' <br /> OA 11 Check Off List. Proofread Report? Correct LAND U E <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 Page-2 December 27,2004 <br />