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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004855 <br /> DATE RECEIVED by EHD: February 22,2005 APPL#: PA-04-620(REG)/ -oy-a.s<ZO <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2691 s ZZ &15b <br /> GEN PLAN AMENDMENT 10+acres(GP) <br /> COMPLETE &SUBMIT BY: Wed, March 2, 2005 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 5184 W ST RT 12 HWY, LODI APN : 05516044 <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 `mLap of area showing population <br /> density, location of house, wind direction, etc.... f/S�_ �a 5� 5 �-Dy L�4d�/,y <br /> Public Water: Public Sewer: �- <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> V V- <br /> I recommend: Approval ❑ Denial ❑ Continuance F-1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> C, IV IV <br /> V c _ <br /> SUPERVISOR/LEAD SENIOR Approval: Date: f <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Page 1 February 24,2005 <br />