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APPLICATION - SITE APPROVAL 4 �?� PRIVATE RIGHT OF WAY - ANTIQUATED SUBDIVISION LlnaRi SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: SA- Other Describe any Items of historical or archaeological interest on-site(e.g.cemeteries or structures): There are no historical or archaeological interests on-site. Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): There is some heavy equipment use (tractors) during farming operations. (Seasonal) Describe any on-site or off-site sources of light or glare(e.g.parking lot lighting,or reflective materials used): There is no proposed on-site or off-site sources of light or glare. Describe any on-site or off-site source of odor(e.g.agricultural wastes): There is very little odor from fertilizers and Government approved pesticides for AS use. Describe any displacement of people that will be caused by the project(e.g.number of people,housing units): There will be no displacement of people as a result of this project. AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. I, further, certify under penalty of perjury that I am (check one): E1 Legal property owner(owner includes partner, trustee, grantor, or corporate officer) of the property(s) involved in this application, or Legal agent (attach proof of the owner's consent to the application of the properties involved in this application and have been authorized to file on their behalf and that the foregoing application statements are true and correct. Print Name: Richard Green Signature: Date: 11/09/2004 Print Name: Kirk Green Signature: ,;V1 4 _ Date: 11/09/2004 Print Name: Signature: Date: Print Name: Signature: Date: Page 5 of 7