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SU0002850
Environmental Health - Public
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EHD Program Facility Records by Street Name
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120 (STATE ROUTE 120)
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1044
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2600 - Land Use Program
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SA-97-54
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SU0002850
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Entry Properties
Last modified
11/19/2024 4:01:41 PM
Creation date
9/8/2019 12:31:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002850
PE
2633
FACILITY_NAME
SA-97-54
STREET_NUMBER
1044
Direction
E
STREET_NAME
STATE ROUTE 120
City
LATHROP
ENTERED_DATE
11/1/2001 12:00:00 AM
SITE_LOCATION
1044 E HWY 120
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\O\HWY 120\1044\SA-97-54\SU0002850\EH PERM.PDF
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 /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner,trustee, trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> u Legal agent (attach proof of the owner's consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf., and that the foregoing <br /> application statements are true and correct. <br /> i <br /> Print Name: _ _ 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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