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SU0010261
EnvironmentalHealth
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PA-1400190
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SU0010261
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Entry Properties
Last modified
11/2/2020 4:46:06 PM
Creation date
9/6/2019 10:16:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0010261
PE
2686
FACILITY_NAME
PA-1400190
STREET_NUMBER
0
STREET_NAME
MOUNTAIN HOUSE
STREET_TYPE
PKWY
City
MOUNTAIN HOUSE
ENTERED_DATE
10/15/2014 12:00:00 AM
SITE_LOCATION
MOUNTAIN HOUSE PKWY
RECEIVED_DATE
10/10/2014 12:00:00 AM
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
Supplemental fields
FilePath
\MIGRATIONS\M\MOUNTAIN HOUSE PKWY\0\PA-1400190\SU0010261\APPL.PDF
Tags
EHD - Public
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AUTHORIZATION SIGNATURES <br /> FP <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> _�::SIGNATURE: <br /> I certify under penalty of perjury that I am (check one): <br /> O Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> I <br /> G 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 <br /> and that the foregoing application statements are true and correct. <br /> Signature: Date: 211- I�.( <br /> Signature: Date: <br /> Signature: Date: <br /> Signature: Date: <br /> Signature: Date: <br /> F Mountain House/MH Application Forms/MH-Plan Title A Form-MASTER <br /> -6- <br />
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