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NOTE: PULL AL =RMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0007831 <br /> DATE RECEIVED by EHD: July 17,2009 ADPL#. PA-0900164 <br /> Referral Agency STAFF CONTACT: RICK GRIFFIN PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: RYE <br /> -- <br /> R. Assigned to : EE0005366 MEDINA <br /> ■ <br /> SITE ADDRESS: 11000 E HWY 12 , LODI APN : 05114006 <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: -7 <br /> Q� <br /> I recommend: Approval Denial Continuance Ins ctor: <br /> Si ature <br /> Supervisor/Lead Senior COMMENTS: y <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> l'rkpfread• e ort7Al <br /> C?A�l Check[? _P _ Correct LAND t7 <br /> Cor 66NIA"1ON(S) �, - o d=in LAND USE BaakT <br /> EH 06 06 Report 47201 July 17,2009 <br />