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SU0004200
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-0400121
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SU0004200
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Entry Properties
Last modified
5/7/2020 11:30:33 AM
Creation date
9/6/2019 10:07:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004200
PE
2632
FACILITY_NAME
PA-0400121
STREET_NUMBER
5024
Direction
N
STREET_NAME
MARKET
STREET_TYPE
ST
City
LINDEN
ENTERED_DATE
5/14/2004 12:00:00 AM
SITE_LOCATION
5024 N MARKET ST
RECEIVED_DATE
3/23/2004 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MARKET\5024\PA-0400121\SU0004200\APPL.PDF \MIGRATIONS\M\MARKET\5024\PA-0400121\SU0004200\CDD OK.PDF \MIGRATIONS\M\MARKET\5024\PA-0400121\SU0004200\EH COND.PDF
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EHD - Public
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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the OwnerlAgent 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 I am (check one): <br /> O Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the properly(s) <br /> involved in this application, or <br /> O 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. l <br /> Print Name:S'Ki)t tool Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: ' Signature: Date: <br />
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