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NOTE: PULL ALL-PERMITS (Septic, Weil, etc.) MAKEVOPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0003424 <br /> DATE RECEIVED by EHD: April 13,2004 APPL#: PA-04-177 <br /> Referral Agency STAFF CONTACT: JOSE RUBIANES PE : 2632 <br /> SITE APPROVAL-GENERAL(SA) <br /> COMPLETE&SUBMIT BY: Tue, May 4, 2004 Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 6318 E ST RT 12 HO Y ,LODI APN : 04912003 <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 /> %j l <br /> I recommend: Approval Denial Continuance ❑ Inspec <br /> Si nature <br /> Suuervisor/Lead Senior COMMENTS: <br /> ITG <br /> R ` 1_ <br /> L 76, 2a ,- 03 Id <br /> 4% -/G* . 0"'� ao -1", <br /> C as : of <br /> 22 <br /> 'O <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA Il Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#72017P . <br /> April 16,2004 <br /> O <br />