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SU0012010
Environmental Health - Public
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EHD Program Facility Records by Street Name
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K
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KELSO
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17590
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2600 - Land Use Program
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PA-1800041
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SU0012010
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Entry Properties
Last modified
5/7/2020 11:35:35 AM
Creation date
9/6/2019 10:36:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0012010
PE
2638
FACILITY_NAME
PA-1800041
STREET_NUMBER
17590
Direction
S
STREET_NAME
KELSO
STREET_TYPE
RD
City
MOUNTAIN HOUSE
Zip
95391-
APN
25803001
ENTERED_DATE
10/9/2018 12:00:00 AM
SITE_LOCATION
17590 S KELSO RD
RECEIVED_DATE
12/19/2018 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\K\KELSO\17590\PA-1800041\SU0012010\APPL.PDF \MIGRATIONS\K\KELSO\17590\PA-1800041\SU0012010\EHD COND.PDF
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EHD - Public
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Describe any displacement of people that will be caused by the project(e.g., numbers of people, housing units): <br /> None. <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE it N APPLICATION. <br /> SIGNATURE: <br /> I 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 property(s) <br /> involved in this application, or <br /> (N Legal agent(attach proof of the owner's consent to the application of the properties involved in this <br /> application)and have been authorized to file on(heir behalf and that the foregoing application <br /> statements are true and correct. <br /> Signature: G '"-- "- _- Date: February 21, 2018 <br /> Signature: Date: <br /> Signature: Date: <br /> Signature: Date: <br /> Signature: Date: <br /> F:Mounlain HooselMH Appllcatlon Forms/MH-Plan Title Amnd Form-MASTER <br /> -6- <br />
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