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SU0004124
Environmental Health - Public
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EHD Program Facility Records by Street Name
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VAN ALLEN
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17327
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2600 - Land Use Program
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PA-0400234
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SU0004124
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Last modified
5/18/2022 5:08:11 PM
Creation date
5/13/2022 2:31:19 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0004124
PE
2631
FACILITY_NAME
PA-0400234
STREET_NUMBER
17327
Direction
S
STREET_NAME
VAN ALLEN
STREET_TYPE
RD
City
ESCALON
APN
20508025
ENTERED_DATE
5/12/2004 12:00:00 AM
SITE_LOCATION
17327 S VAN ALLEN RD
RECEIVED_DATE
5/12/2004 12:00:00 AM
P_LOCATION
06
P_DISTRICT
004
QC Status
Approved
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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 Owner/Agent 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 /> 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 /> L_ 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: j'}/drW AS Signature: Date: y 3 a u <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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