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SU0014951
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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9810
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2600 - Land Use Program
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PA-0300388
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SU0014951
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Entry Properties
Last modified
11/19/2024 3:48:20 PM
Creation date
6/7/2022 11:56:16 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0014951
PE
2600
FACILITY_NAME
PA-0300388
STREET_NUMBER
9810
Direction
E
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240-
APN
05112062
ENTERED_DATE
5/24/2022 12:00:00 AM
SITE_LOCATION
9810 E HWY 12
QC Status
Approved
Scanner
SJGOV\sballwahn
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 /> 1, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and Its agents, officers and <br /> omployaos from any claim, action or procooding against the Ownor/Agont's project. <br /> l. I, fhor, cortlfyundorponaltyofperjuryt/iat1ani (cliockono): <br /> gal 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 of the owner's consont 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 /> Print Name: -A Signature: Date: 7- U <br /> Print Name: Jam(\ u')0.\-V5 Signature: Date: <br /> Print Name: �(� �, �� L �� h Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />
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