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e <br /> n?•�+u'?`� l+ <br /> x' APPLICATION -- SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-- ANTIQUATED SUBDIVISION <br /> _ SAN JOAC.UIN COUNTY DOIVIMUNITy DEVELOPMENT_DEPARMENT <br /> FIiLE_NUMBERs SA- <br /> 'C' <br /> Describe any items of historical or archaeological tntergst on-site;0.g_cemeferies or_Actures : <br /> Describe an ori=site br off-site sources of noise o,r vdbMtlor e. '.freewa noise,ilea e.ui M'ent etc. : `" &M e_ <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> r ati fP t,� <br /> Describe any on-site or off-site source of odor e. .a ricuttural wastes <br /> Do_0r .[ ! <br /> Describe any displacement of people that will be caused bX the project(e.g.numbers of people,housing units): "a4C <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENTMAY FILE AN APPLICATION. <br /> I, the OwrEer/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 <br /> i, further, certify under penalty of perjury that I am (check one): i <br /> �. Legal property owner (owner includes.partner, trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> 0 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 ontheir behalf and that the foregoing-application statements <br /> are true and correct. <br /> Print Name: ignature: Date: D <br /> Print Name: A 17• Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSVC1PlanMng Application FormslSite Approval) Page 5 of 7 <br /> Private Right of Way.[Revised4-2-03 <br />