Laserfiche WebLink
APPLICATION - CERTIFICATE OF COMPLIANCE <br /> _ i __ -54G <br /> 4U' ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,Y FILE NUMBER: ccPA ? 20007 ? <br /> QCtr(�T <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Owner Information Engineer/Applicant Information <br /> Name: Komalpreet Atwal,Sukhjeven Atwal,and Name: Quartaroli&Associates,Ince <br /> Bhavanpreet Atwal Contact: John Glick <br /> Address: P.O. Box 1169 Address: 310 Sun West Place Suite A <br /> Tracy, CA 95378 Manteca,CA 95337 <br /> Phone: Phone: (209)239-4908 <br /> Email: johnglick@quartaroli.com <br /> Property Address: Not Assigned <br /> Assessor Parcel Number(s): 253-240-15 <br /> PROPERTY HISTORY <br /> Give a history of the parcel(when created, by whom,any boundary modifications, ownership record,etc.)and any building <br /> construction history that may have a bearing on the parcel: <br /> Parcel One: <br /> Parcel as described in Deed from Harriet C. Huggins to Banta-Carbona Irrigation District, recorded on June 27, 1925 in Book <br /> of Official Records,Volume 92,at Page 195,San Joaquin County Records. <br /> II 1 <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 employees from any claim, <br /> action or proceeding against the County arising from the Owner/Agent's project. <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)involved in this application, <br /> or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been <br /> authorized to file on their behalf.,and that the foregoing pl�lication statements are true and correct. <br /> ii <br /> Print Name: Komalpreet Atwal Signature: r � Date: <br /> Print Name: Sukhjeven Atwal Signature:: /�'J v�'Uv Date: <br /> Print Name:,BhavanpreetAtwal Signature: 1✓ 1 Dater <br /> r <br /> i <br /> Print Name: Signature: Date: <br /> F:\DEVSMPlanning Application Forms\Deviation.doc.(Revised 5-11-09) Page 1 of 1 Job No 2020-92 CC <br />