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SU0004253
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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26 (STATE ROUTE 26)
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18699
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2600 - Land Use Program
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PA-0300293
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SU0004253
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Last modified
11/20/2024 8:50:26 AM
Creation date
6/7/2022 10:00:34 AM
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EHD - Public
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APPLICATION - SITE APPROVAL <br /> FEAUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPL/CATIO <br /> N. <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 proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that/am (check one): <br /> Legal property owner(owner Includes partner, trustee, trustor, or c <br /> Involved In this application, or corporate officer) of the property(s) <br /> L7 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., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: - <br /> c-,) Signature: <br /> Print Name: Date: <br /> Signature: -- <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: �—' <br /> Print Name, pignaturel Da to: <br /> O.a1 <br />
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