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NOTE: PULL ALLVIRMITS (Septic, Well, etc.) MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004699 <br /> DATE RECEIVED by EHD: November 09,2004 APPL#: PA-04-620 Pre-Application <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2691 <br /> GEN PLAN AMENDMENT 10+acres(GP) <br /> COMPLETE& SUBMIT BY: Wed, December 1, 2004 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 5184 W ST RT 12 HWY, LODI APN : 05516022 <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 F-1 Denial F-1 Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITIONS)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 Pape I November 17,2004 <br />