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SU0013564
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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SU0013564
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Entry Properties
Last modified
9/1/2020 3:10:03 PM
Creation date
8/7/2020 11:03:31 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0013564
PE
2632
FACILITY_NAME
PA-2000065
STREET_NUMBER
17400
Direction
W
STREET_NAME
BETHANY
STREET_TYPE
RD
City
TRACY
Zip
95391-
APN
20915029
ENTERED_DATE
8/5/2020 12:00:00 AM
SITE_LOCATION
17400 W BETHANY RD
RECEIVED_DATE
7/31/2020 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
TSok
Tags
EHD - Public
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AUTHORIZATION SIGNATURES <br /> ONLY THE'OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> SIGNATURE: <br /> I 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 /> X 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 <br /> and that the foregoing application statements are true and correct. <br /> Signature: �, Date: 3/4/20 <br /> Signature: Date: <br /> Signature: Date: <br /> I <br /> Signature: Date: <br /> Signature: Date: <br /> F.Mount-House/MH Application F—IMH-Plan Title Amnd For MASTER <br /> -6- <br />
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