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SU0012654
Environmental Health - Public
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SU0012654
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Last modified
2/25/2020 3:53:16 PM
Creation date
11/26/2019 9:15:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0012654
PE
2690
FACILITY_NAME
PA-1900168
STREET_NUMBER
19729
Direction
S
STREET_NAME
CARROLTON
STREET_TYPE
RD
City
RIPON
Zip
95366-
APN
24513061, 24538020, 24538021, 24538036
ENTERED_DATE
11/20/2019 12:00:00 AM
SITE_LOCATION
19729 S CARROLTON RD
RECEIVED_DATE
11/20/2019 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
TSok
Tags
EHD - Public
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�U Nc <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> �,r.......... <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �.k, <br /> • FILE NUMBER: <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 <br /> employees 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 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 /> APN 245-130-61 <br /> Koolhaas Family Limited Partnership / / <br /> Print Name: �� 1� I'1 e 16b1JGcs,Lq" Signature: Date: 7! �6 <br /> > > -Oi+ �1S Signature: � "l Z� _ , GSC Date: 7-A/ <br /> Print Name: � i�k�rt) C �< �- A <br /> APN 245-380-21,35,36,a port.of 20 and 52 <br /> Kenneth Koolhaas and Corrine Koolhaas,Trustees of the Koolhaas Family Revocable Trust dated December 6,2017/ <br /> Print Name: Kenneth Koolhaas,Trustee Signature: J --r Date: 7 �/6 !� -o/� t <br /> Jl <br /> Print Name: Corrine Koolhaas.Trustee Signature: u� � � Date: -7 -11-, <br /> FMEVSMPlanning Application Forms\ Page 3 of 3 Job NO 2019-140 LLA <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />
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