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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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UPISAVP <br /> AUTHORIZATION SIGNATURES <br /> ONLYTHE OWNER OF THE PROPERTY OR ANAUTN01VIZEDAGENTMAYF%LEAN APPLICATION. <br /> 1,Iha Owner/Agent agree,fo dehad,lndoeudle 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, --mly undarpanalty 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 beha/r) <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 /> Afountaln H..IMHApplk4Vm FwmsWH-UP-SA-IPform-HASTE P dac <br />
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