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SU0000584
Environmental Health - Public
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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12366
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2600 - Land Use Program
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MS-97-24
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SU0000584
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Entry Properties
Last modified
11/19/2024 3:48:08 PM
Creation date
9/9/2019 10:23:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0000584
PE
2622
FACILITY_NAME
MS-97-24
STREET_NUMBER
12366
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
ENTERED_DATE
9/24/2001 12:00:00 AM
SITE_LOCATION
12366 W HWY 12
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\T\HWY 12\12366\MS-97-24\SU0000584\APPL.PDF
Tags
EHD - Public
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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <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 from any claire, actlon <br /> or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am(check one): <br /> xLegal property owner(owner Includes partner,trustee,trustor,or corporate officer) of the property(s) Involved In <br /> this application,or <br /> 11 Legal agent (attach proof of the owner's consent to the application of the property's involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> /� / <br /> Print Name: p IUez ✓`sGr 5 y,LC Signature: - ✓`2S Date: 46 �Z <br /> Print Name: T Lpasta 9- LR C,c ? r A Signature Date: 40- 5;e- 5 7 <br /> Print Name: }'.c-tZ ALKApISJp Q12CffAI22SJAJ§Ignature: K05;.Date: /l ' 3 'G1-7 <br /> Print Narne: _ Signature: Date: <br /> Print Name: Signature: Date: <br /> -s- <br />
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