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NOTE: PULL ALL RMITS {Septic, Well, etc,) MAKE PIES FOR FILE <br /> LAND USE REPORT RECORD rD: SU0006912 <br /> DATE RECEIVED by EHD: December 26,2007 APPL#: PA-0700591 <br /> Referral Agency STAFF CONTACT: PATRICK CROSBY PE : 2690 <br /> COMPLETE& SUBMIT BY: A PS A P. <br /> LOT LINE ADJUSTMENT(LA) <br /> y <br /> r <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 16974 N TRETHEWAY RD, LODI APN : 05119016 02 <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 /> r <br /> I recommend: Approval Denial Continuance Ins c Qr. <br /> Supervisor/Lead Senior COMMENTS: tature <br /> 7 <br /> 'I <br /> SUPERVISOR/LEAD SENIOR Approval: Date: 7/? <br /> Clr1'ck;Off C s Prop eali ,_ �d` „ ce l T f11VD ti7S 2 <br /> nfrect CONDITIONS 7; ro CISIs Boake <br /> H 06 06 Report#17201 December 26,2007 <br />