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SU0011276
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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PA-1700047
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SU0011276
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Entry Properties
Last modified
11/2/2020 4:55:30 PM
Creation date
9/4/2019 9:55:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0011276
PE
2632
FACILITY_NAME
PA-1700047
STREET_NUMBER
0
STREET_NAME
MOUNTAIN HOUSE
STREET_TYPE
PKWY
City
MOUNTAIN HOUSE
Zip
95391-
APN
25403001
ENTERED_DATE
3/23/2017 12:00:00 AM
SITE_LOCATION
MOUNTAIN HOUSE PKWY
RECEIVED_DATE
3/20/2017 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\wng
Supplemental fields
FilePath
\MIGRATIONS\M\MOUNTAIN HOUSE PKWY\0\PA-1700047\SU0011276\MISC.PDF
Tags
EHD - Public
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AUTHORIZATION SIGNATURES <br />ONLY THE OWNER OF THE PROPERTY OR ANAUTN01VIZEDAGENTMAYF%LEAN APPLICATION. <br />1, Iha Owner/Agent agree, fo dehad, Indoeudle and hold harmffiss the County and/h, agents, of lcors and employees from any <br />claim, aglon orpraceeding against fhe Owner/Agents project <br />I. fumh d, --my undarpanalfy ofperfury foal) am (chock ono): <br />❑ Legal ropery Owner(--or Includes psNner, kosteo, frusfo% or corporate ofgcoo cribs puporty(s) <br />/ adin Pols application, or <br />Legal agent (attach probfof the owner's consent to the application of the pneperfy's Inwlved In this <br />appllcagon and have been authorized to filo on thele behalf) <br />and that the foregoing application statements are true and conva <br />Print Name: `i � �T _ Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Data; <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Afounlaln H..IMHApplkegon Fw SWH-UP-SA-IPform-MASTER.dac <br />
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