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SU0004481
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4 (STATE ROUTE 4)
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18417
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2600 - Land Use Program
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PA-0400232
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SU0004481
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Entry Properties
Last modified
11/20/2024 9:09:38 AM
Creation date
9/4/2019 6:45:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004481
PE
2631
FACILITY_NAME
PA-0400232
STREET_NUMBER
18417
Direction
E
STREET_NAME
STATE ROUTE 4
City
STOCKTON
ENTERED_DATE
5/24/2004 12:00:00 AM
SITE_LOCATION
18417 E HWY 4
RECEIVED_DATE
5/19/2004 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\F\HWY 4\18417\PA-0400232\SU0004481\APPL.PDF
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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 /> [L7 <br /> Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> oyees from any claim, action or proceeding against the Owner/Agent's project. <br /> rther, 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 /> ved in this application, orLegal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> cation and have been authorized to file on their behalf., and that the foregoing application statements <br /> ue and correct. <br /> Print Name: !� —)' ��Jy� <br /> H���-� n6 Mai Signature: =�I ( _ 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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