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SU0002594
EnvironmentalHealth
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2600 - Land Use Program
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SA-00-19
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SU0002594
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Entry Properties
Last modified
5/7/2020 11:29:19 AM
Creation date
9/6/2019 9:59:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002594
PE
2633
FACILITY_NAME
SA-00-19
STREET_NUMBER
4125
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
ENTERED_DATE
10/31/2001 12:00:00 AM
SITE_LOCATION
4125 E MAIN ST
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\4125\SA-00-19\SU0002594\APPL.PDF \MIGRATIONS\M\MAIN\4125\SA-00-19\SU0002594\EH COND.PDF \MIGRATIONS\M\MAIN\4125\SA-00-19\SU0002594\PUB REC REL APPL.PDF
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EHD - Public
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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent 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 /> ALegal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ 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 /> g <br /> Print Name: uy#' ��"�'t"�C�(a" � Signature: - Date. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />
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