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SU0004273
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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99 (STATE ROUTE 99)
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12680
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2600 - Land Use Program
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PA-0300121
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SU0004273
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Entry Properties
Last modified
11/19/2024 1:58:51 PM
Creation date
9/8/2019 12:52:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004273
PE
2632
FACILITY_NAME
PA-0300121
STREET_NUMBER
12680
Direction
N
STREET_NAME
STATE ROUTE 99
City
LODI
ENTERED_DATE
5/17/2004 12:00:00 AM
SITE_LOCATION
12680 N HWY 99
RECEIVED_DATE
4/1/2003 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\N\HWY 99\12680\PA-0300121\SU0004273\EH PERM.PDF
Tags
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 /> Legal 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 /> Print Name: ��//C /4/�J�L'V • S, m 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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