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SU0004855
Environmental Health - Public
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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2600 - Land Use Program
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PA-0400620
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SU0004855
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Last modified
11/19/2024 3:48:12 PM
Creation date
9/9/2019 10:25:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004855
PE
2691
FACILITY_NAME
PA-0400620
STREET_NUMBER
5184
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
APN
05516044
ENTERED_DATE
2/22/2005 12:00:00 AM
SITE_LOCATION
5184 W HWY 12
RECEIVED_DATE
2/22/2005 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\T\HWY 12\5184\PA-0400620\SU0004855\CDD OK.PDF
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EHD - Public
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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)/PH <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2691 <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 map of area showing population <br /> density, location of house, wind direction, etc.... , use— 6o5sC 2, <br /> Public Water: Public Sewer: �/I- <br /> }� <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> 1 i <br /> I recommend: Approval F-1 Denial 7 Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> s � <br /> i <br /> —Del y � < c <br /> vDlop , r— <br /> LLQ- G3ae-,-tr2. <br /> o o1 <br /> t <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <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 />
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