Laserfiche WebLink
E t <br /> J <br /> °PauF" APPLICATIONITE APPROVAL A <br /> r <br /> PRIVATE RIGHT OF WAY — ANTIQUATED SUBDIVISION s <br /> '= SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> f Other <br /> Describe any items of historical or archaeological interest on-site e. . cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heayy equipment,etc. : <br /> tc-J 6-kh-o— G�-. r"L44, is dnt to <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting,or reflective materials used): <br /> i <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <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 /> I <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ 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: -TO I r, -F M ty14 Signature: Date: <br /> pp /J r <br /> Print Name: ic L&I-),t- f� 1> Signature: 1'�l� 9.- ' <br /> Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F_IDEVSVC\Planning Application Forms\Site Approval) Page 5 of 7 <br /> Private Right of Way.{Revised4-2-03 <br />