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SU0014557
EnvironmentalHealth
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2600 - Land Use Program
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SU-87-4
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SU0014557
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Last modified
6/23/2022 12:08:40 PM
Creation date
6/10/2022 2:33:55 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0014557
PE
2600
FACILITY_NAME
SU-87-4
STREET_NUMBER
0
STREET_NAME
MOKELUMNE
STREET_TYPE
ST
City
WOODBRIDGE
APN
01508001
ENTERED_DATE
12/8/2021 12:00:00 AM
SITE_LOCATION
MOKELUMNE ST
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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e <br /> ADDITIONAL APPLICATIONS <br /> Will other applications or permits be required to complete the pro- <br /> ject (If yes, list all required local, State and Federal permits ) : <br /> Body -Type of Permit <br /> SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Owner (s ) (All owners must sign as their names appear on the <br /> deed. ) , <br /> �] Corporate Officer(s ) empowered to sign for the corporation, <br /> L_-I Owner 's legal agent having Power of Attorney for this action (a <br /> notorized Power of Attorney document must accompany the <br /> application ) , <br /> and that th foregoing is true and correct . / <br /> -7/2 <br /> ignature ) (D t ) <br /> X � �- <br /> (Signature) (Date ) <br /> Remember, you must attach a copy of your deed and maps to this <br /> application. <br /> ! • R <br /> 4 <br />
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