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SU0004385
Environmental Health - Public
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EHD Program Facility Records by Street Name
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6361
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2600 - Land Use Program
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SA-01-80
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SU0004385
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Entry Properties
Last modified
11/19/2024 3:48:12 PM
Creation date
9/9/2019 10:26:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004385
PE
2632
FACILITY_NAME
SA-01-80
STREET_NUMBER
6361
Direction
W
STREET_NAME
STATE ROUTE 12
City
LOCKEFORD
ENTERED_DATE
5/19/2004 12:00:00 AM
SITE_LOCATION
6361 W HWY 12
RECEIVED_DATE
10/30/2001 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\T\HWY 12\6361\SA-01-80\SU0004385\CDD OK.PDF
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EHD - Public
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f <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> XX Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> O Legal agent(attach proof or the owners c ;s,s�:,t.:, thv app caticn of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements are <br /> true and correct. <br /> HIGHWAY 12 INVESTORS, LLC l LA, <br /> BY: KEVIN HUBER Signature: I Date: /U-/O'G/ <br /> Print Name: 9 <br /> Print Name: Signature: Date: <br /> LPrnin, e: Signature: Date: <br /> e: Signature: Date: <br /> e: Signature: Date: <br />
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