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SU0002485
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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T
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12 (STATE ROUTE 12)
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5100
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2600 - Land Use Program
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SA-01-50
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SU0002485
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Entry Properties
Last modified
11/19/2024 3:48:10 PM
Creation date
6/7/2022 8:53:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002485
PE
2633
FACILITY_NAME
SA-01-50
STREET_NUMBER
5100
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
ENTERED_DATE
10/29/2001 12:00:00 AM
SITE_LOCATION
5100 W HWY 12
QC Status
Approved
Scanner
SJGOV\sballwahn
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 /> O Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> Involved In this application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved 1n 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: ��h�� ���`l�U�L 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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