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SU0013292
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LEGACY
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2600 - Land Use Program
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PA-2000073
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SU0013292
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Entry Properties
Last modified
10/27/2021 10:52:59 AM
Creation date
5/13/2020 4:51:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0013292
PE
2634
FACILITY_NAME
PA-2000073
STREET_NUMBER
255
Direction
W
STREET_NAME
LEGACY
STREET_TYPE
DR
City
MOUNTAIN HOUSE
Zip
95391-
APN
25423003
ENTERED_DATE
5/13/2020 12:00:00 AM
SITE_LOCATION
255 W LEGACY DR
RECEIVED_DATE
5/8/2020 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\tsok
Tags
EHD - Public
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UP/SA/IP <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION, <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any <br /> claim, action or proceeding against the Owner/Agent 's project. <br /> 1, further, certify under penalty of perjury that 1 am (check one) : <br /> A Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ 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 /> Chandra Sirapu ' <br /> Print Name : Signature: Date: 04/ 15 /2020 <br /> Print Name : Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature : Date : <br /> Print Name: Signature : Date: <br /> Mountain HouselMH Application FormsIMH- UP-SA-IP form-MASTER. doc <br />
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