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SU0009324
Environmental Health - Public
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EHD Program Facility Records by Street Name
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LARCH
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2600 - Land Use Program
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PA-1200133
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SU0009324
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Entry Properties
Last modified
5/7/2020 11:33:57 AM
Creation date
9/6/2019 10:47:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0009324
PE
2631
FACILITY_NAME
PA-1200133
STREET_NUMBER
11075
Direction
W
STREET_NAME
LARCH
STREET_TYPE
RD
City
TRACY
Zip
95376-
APN
21217002
ENTERED_DATE
8/24/2012 12:00:00 AM
SITE_LOCATION
11075 W LARCH RD
RECEIVED_DATE
8/23/2012 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\L\LARCH\11075\PA-1200133\SU0009324\APPL.PDF \MIGRATIONS\L\LARCH\11075\PA-1200133\SU0009324\CDD OK.PDF \MIGRATIONS\L\LARCH\11075\PA-1200133\SU0009324\EH COND.PDF \MIGRATIONS\L\LARCH\11075\PA-1200133\SU0009324\CORRESPOND.PDF
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EHD - Public
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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 <br /> employees from any claim, 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 /> (X) (X) Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Willis Hill Signature: .901 Date: 6/28/12 <br /> Print Name: Tiny Hill Signature: Z�43f,/ Date: 6/28/12 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\PlanninB Application Forms\Sae Approval.(Revised 02-03-10) Page 10 of 9 <br />
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