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SU0015842
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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PA-2300150
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SU0015842
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Entry Properties
Last modified
6/26/2024 8:02:20 AM
Creation date
9/21/2023 10:15:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0015842
PE
2611
FACILITY_NAME
PA-2300150
STREET_NUMBER
19300
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
MOUNTAIN HOUSE
Zip
95391-
APN
20906068
ENTERED_DATE
9/21/2023 12:00:00 AM
SITE_LOCATION
19300 W GRANT LINE RD
RECEIVED_DATE
9/20/2023 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\gmartinez
Tags
EHD - Public
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u.iwvyi �i . .c .�.c ... . . vi . tvvu-cv�u�vvv-u �u i -uvuu. �rv.� i �v <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION, <br /> SIGNATURE: <br /> 1 certify under penalty of perjury that I am (check one): <br /> 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 /> Docuftned by: <br /> Signature: by: So& 6 Date: <br /> e 7 e 8 4FF/. 1 . 5 / 31/2023 <br /> Signature: 0� �� µ Date: <br /> F 83768C4FE... <br /> Signature: oe i9nedby: Date : <br /> 1 5 / 31/2023 <br /> Signature: e, 6 Date : <br /> Signature: Date : 5 / 31/ 2023 <br /> F:Mounlain Housel H A,PP <br /> icalm r IM - an a nmd Form-MASTER <br /> 45594 D94E8646B... <br />
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