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SU0002549
Environmental Health - Public
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EHD Program Facility Records by Street Name
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LIBERTY
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11964
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2600 - Land Use Program
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SA-02-01
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SU0002549
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Entry Properties
Last modified
5/7/2020 11:29:17 AM
Creation date
9/6/2019 10:51:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002549
PE
2633
FACILITY_NAME
SA-02-01
STREET_NUMBER
11964
Direction
E
STREET_NAME
LIBERTY
STREET_TYPE
RD
City
GALT
ENTERED_DATE
10/29/2001 12:00:00 AM
SITE_LOCATION
11964 E LIBERTY RD
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\L\LIBERTY\11964\SA-02-01\SU0002549\APPL.PDF \MIGRATIONS\L\LIBERTY\11964\SA-02-01\SU0002549\CDD OK.PDF \MIGRATIONS\L\LIBERTY\11964\SA-02-01\SU0002549\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 /> 1, 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 OwnerlAgent's project. <br /> I, 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 property(s) <br /> involved in this application, or <br /> Q 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: , AMZ4 F1rJrJ6&i rJ 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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