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SITE IMPROVEMENT PLAN <br /> SAN JOAQUIN GOI1NTY COMMUNI fY DEVELOPMEN l OF-PARTMENT <br /> FILE NUMBER: IP <br /> �i+6 <br /> ExWing Roads _ <br /> i2narV,9t-wt Name POW Width Pwernpxt 1'Vidth CyrbmU Ltef Sidewcdks <br /> None YPs [j Nv Ll Yes [j No i_] <br /> i{ Yes L1 No❑ Yab L] No <br /> i AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent ages, to defand, indemnify. and hatd harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> 1,further, certify under penalty of po-xy that I am (check one). <br /> r <br /> ® Legal property owner (owner includes partner, trustee, IrLmtor, or c(uporate officer)of the property(s) <br /> I lnvolved in this application, or <br /> Legal agent(attach proof of the awner's consent to the application of the property's involved in this <br /> application and have been authorized to lite on their behalf., and that the foregoing application slatenen�.s <br /> are true and correct. <br /> Prot Ntui*: David Wheeler — Signatwe: ��—�c� — <br /> Pr"Name. -- _ Srgrrrmure _ trate. <br /> Prni Narnc: SkKiakre: --- Date; <br /> Prat Name _ Si9nalur: Date: <br /> Drat N7t„Q: _ Vii¢atur�_ Data._ <br /> r':J)FVSVC0'.t--diM19APnlic-7ice Farr.iuSft vIRT;vwmpjr-vi L page d of 9 <br /> irzeY:w s-n ism <br />