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SU0002671
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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ESCALON BELLOTA
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11655
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2600 - Land Use Program
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SA-99-42
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SU0002671
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Entry Properties
Last modified
11/27/2019 11:11:53 AM
Creation date
9/4/2019 6:07:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002671
PE
2633
FACILITY_NAME
SA-99-42
STREET_NUMBER
11655
Direction
S
STREET_NAME
ESCALON BELLOTA
STREET_TYPE
RD
City
ESCALON
ENTERED_DATE
10/31/2001 12:00:00 AM
SITE_LOCATION
11655 S ESCALON BELLOTA RD
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\E\ESCALON BELLOTA\11655\SA-99-42\SU0002671\PUB REC REL APPL.PDF
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EHD - Public
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9 <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and its agents,officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> ® Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf, and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Frank Borba Signatu <br /> Print Name: Caro] Borba Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> dz��h <br />
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