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SU0014945
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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SA-96-35
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SU0014945
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Entry Properties
Last modified
6/14/2022 7:00:40 PM
Creation date
6/7/2022 11:42:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0014945
PE
2600
FACILITY_NAME
SA-96-35
STREET_NUMBER
250
STREET_NAME
ROTH
STREET_TYPE
RD
City
LATHROP
Zip
95330-
ENTERED_DATE
5/23/2022 12:00:00 AM
SITE_LOCATION
250 ROTH RD
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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18 <br /> Agent Authorization Form <br /> I(�,�,.N•oa P /Z" L C-C, is the owner of <br /> the subject property for which the following application(s) have been submitted: <br /> Application Name and Number(s): D () - D 117 <br /> The subject properties are located at: <br /> 2 S-O E. k 40A Z*r-/ro?' 04. 15330 <br /> APNs: <br /> The Agent for this project is: " <br /> Name: i`aMo�y� � s �G �ovT,a(- •` /�/f• -+� o.J <br /> Address: S �• �oa� ���`�� . �S-�3Z> <br /> Telephone: <br /> Fax Number: 2-0 - p83 - LIAOSs <br /> Signatures of Owners: (%w� <br /> Type or Print Name <br /> Type or Print Name <br /> Type or Print Name <br /> Type or Print Name <br /> Note: Owner of record should be as shown on the latest equalized rolls of San Joaquin County - an <br /> option to purchase does not constitute ownership. If ownership has recently been transferred, a copy of <br /> recorded deed or similar instrument must accompany this form. <br /> hAcdd\administrative approval application 2000 <br />
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