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SU0003481
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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PA-0300653
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SU0003481
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Entry Properties
Last modified
5/7/2020 11:29:56 AM
Creation date
9/4/2019 9:36:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0003481
PE
2690
FACILITY_NAME
PA-0300653
STREET_NUMBER
395
Direction
E
STREET_NAME
ACAMPO
STREET_TYPE
RD
City
ACAMPO
ENTERED_DATE
4/30/2004 12:00:00 AM
SITE_LOCATION
395 E ACAMPO RD
RECEIVED_DATE
12/17/2003 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\A\ACAMPO\395\PA-0300653\SU0003481\APPL.PDF \MIGRATIONS\A\ACAMPO\395\PA-0300653\SU0003481\CDD OK.PDF \MIGRATIONS\A\ACAMPO\395\PA-0300653\SU0003481\EH COND.PDF \MIGRATIONS\A\ACAMPO\395\PA-0300653\SU0003481\PUB REC REL APPL.PDF
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EHD - Public
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LOT LINE ADJUSTMENT <br /> fSAN J A U!N COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> QNATURES -7 <br /> 1, the Owner/Agent agree, to defend,lndemnlfy,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 /> II <br /> Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the property(s)Involved In <br /> this application, or <br /> O Legal ad nt(attach proof of the owner's consent to the application of the property's involved 1n this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> .Y <br /> Print-Name: e�' L. � -' _ Signature: --•....�, -^- •,_ <br /> Date <br /> Signature. <br /> _ Data: <br /> Print Name: 9 <br /> Print Name: Z.,d2aZ5 1/,�, <br /> it Signature:C' Data: <br /> Print Name: � Signature: <br /> Date: <br /> S! nature: Date: <br /> Print Name: g <br /> i <br /> I <br /> II ' <br /> I <br /> I , <br /> 'I <br /> I <br /> r <br /> 9 <br /> it 5 <br /> it <br /> it <br /> I' <br /> I <br /> r <br />'Iti'wwrl'rJrtG�' _ _ - <br /> - <br /> I I <br /> I <br /> i <br /> FtUWSCR/1MR%/PlJJiAPP9/LOTLINFADJAPP EbPIS REV 2/1/99 -4- <br /> l <br /> �y <br />
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