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SU0012929
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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COLLIER
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3706
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2600 - Land Use Program
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PA-03-403
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SU0012929
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Entry Properties
Last modified
1/16/2020 9:31:21 AM
Creation date
9/4/2019 11:27:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0012929
PE
2610
FACILITY_NAME
PA-03-403
STREET_NUMBER
3706
Direction
E
STREET_NAME
COLLIER
STREET_TYPE
RD
City
ACAMPO
Zip
95220-
APN
00514225
ENTERED_DATE
1/16/2020 12:00:00 AM
SITE_LOCATION
3706 E COLLIER RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\C\COLLIER\3706\PA-0300403\EH PERM.PDF
Tags
EHD - Public
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APPLICATION - SITE APPROVAL }} <br /> I <br /> A UTHORIZA TION SIGNATURES <br /> :ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED°AGENT MAY FI1;E AN.APPLICATION. <br /> 1, the Owner/Agent agree, to defend, Indemnify, and hold harmless the County and Its agents, officers and <br /> employees from any claim, action or procooding against the Ownor/Agent's project. <br /> 1, further, certify under penalty of perjury that l am (check one): <br /> D Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application,or <br /> p Legal agent(attach proof of the owner's consent to the application of the property's lnvolved In this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are trueand correct. <br /> ✓/?? �J Yl Signature: r. ` Date. v� �r <br /> Print Nae:m - <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: Date: _ <br /> Print Name: Signature: Date: _ <br /> Date: <br /> Print Name: Signature. <br /> it <br />
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