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SU0002821
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WATERLOO
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8767
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2600 - Land Use Program
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SA-98-03
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SU0002821
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Entry Properties
Last modified
11/22/2019 11:16:10 AM
Creation date
11/22/2019 11:11:37 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002821
PE
2633
FACILITY_NAME
SA-98-03
STREET_NUMBER
8767
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
ENTERED_DATE
11/1/2001 12:00:00 AM
SITE_LOCATION
8767 WATERLOO RD
QC Status
Approved
Scanner
SJGOV\gmartinez
Tags
EHD - Public
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T <br /> 1 <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, 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 /> I <br /> I, 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 are <br /> true and correct. <br /> Print Name: Z Z7� , , 5ignatur / ?' Date: ` G <br /> 7Z* <br /> Print Name: �C' 17� ! Signature: G� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> iPrint Name: Signature: Date: <br />
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