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SU0000087
Environmental Health - Public
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EHD Program Facility Records by Street Name
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FOREST LAKE
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2600 - Land Use Program
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MS-99-09
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SU0000087
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Entry Properties
Last modified
11/21/2019 10:21:27 AM
Creation date
11/21/2019 9:46:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0000087
PE
2622
FACILITY_NAME
MS-99-09
STREET_NUMBER
1120
Direction
W
STREET_NAME
FOREST LAKE
City
ACAMPO
ENTERED_DATE
8/8/2001 12:00:00 AM
SITE_LOCATION
1120 W FOREST LAKE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\gmartinez
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 /> rFI,theOwner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the OwnerlAgent's project. <br /> I,further, certify under penalty of perjury that I am(check one): <br /> IN Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> he owner's consen <br /> to the <br /> plication of the property's involved In <br /> his <br /> O and ha eebeen autho authorized totfile on their behalf.tand that nt <br /> Legal agnt(atch proof of e foregoing application on statementsare true aition <br /> and <br /> correct. <br /> Print Name: <br /> David W. Fisher Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -5- <br />
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