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SU0004941
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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21905
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2600 - Land Use Program
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PA-0500105
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SU0004941
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Entry Properties
Last modified
11/19/2024 3:48:13 PM
Creation date
9/9/2019 10:24:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004941
PE
2690
FACILITY_NAME
PA-0500105
STREET_NUMBER
21905
Direction
E
STREET_NAME
STATE ROUTE 12
City
CLEMENTS
APN
02310024, 26, &
ENTERED_DATE
3/23/2005 12:00:00 AM
SITE_LOCATION
21905 E HWY 12
RECEIVED_DATE
3/23/2005 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\T\HWY 12\21905\PA-0500105\SU0004941\CDD OK.PDF
Tags
EHD - Public
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. t <br /> i <br /> LOT LINE ADJUSTMENT <br /> 3AN JOA UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ALUT ORIZA TION SIGNATURES <br /> ON YT E OWNER&TMEF OFERl"YORANAfJTNOItIZED',4GE MAYFLEAN I1PPLlCATI N. <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> O Legal property owner(owner includes partner, trustee,grantor,or corporate officer)of the property(s)involved in <br /> this application, or <br /> O Legal agent(attach proof of the owners consent to the application of the property's involved in this application and <br /> have been authorized to rile on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: __..Brent Newport Signature: � <br /> Date: <br /> Print Name: Christy Newport Signature: p���(}—�'}j <br /> Date; <br /> Print Name: Zaba��os Propertj es Signature. *'0-40,; <br /> Date:. 116105 <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br />- Date: <br />
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