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SU0004262
Environmental Health - Public
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EHD Program Facility Records by Street Name
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TULLY
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2600 - Land Use Program
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PA-0300074
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SU0004262
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Entry Properties
Last modified
5/7/2020 11:30:36 AM
Creation date
9/9/2019 10:46:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004262
PE
2632
FACILITY_NAME
PA-0300074
STREET_NUMBER
25407
Direction
N
STREET_NAME
TULLY
STREET_TYPE
RD
City
ACAMPO
ENTERED_DATE
5/17/2004 12:00:00 AM
SITE_LOCATION
25407 N TULLY RD
RECEIVED_DATE
3/4/2003 12:00:00 AM
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\T\TULLY\25407\PA-0300074\SU0004262\APPL.PDF \MIGRATIONS\T\TULLY\25407\PA-0300074\SU0004262\CDD OK.PDF \MIGRATIONS\T\TULLY\25407\PA-0300074\SU0004262\EH COND.PDF \MIGRATIONS\T\TULLY\25407\PA-0300074\SU0004262\EH PERM.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 Owner/Agent agree, to defend, Indemnify, and hold harmless the County and Its agents, officers and <br /> employees from any claim, action or proceeding'agalnst the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> ILegal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> nvolved In this appllcatlon, or <br /> C 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 Elle on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: ''1��t }���( �E (. iD�P'tignature: t-(> Date: ZO O <br /> Print Name: Signature. Date: <br /> Print Name: Signature: Date: <br /> Print Name: Slgnaturo: Dato: <br /> Pint Names vignatur+l <br /> Patel �� <br />
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