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69/27/2004 09:05 FAX 5270365 <br /> APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY L)EVELOF-MEA,'TDEPARTMENT <br /> FILE NO.:SA- <br /> Demwibe any items of tisbrical or archaeological intareston-sIte(e.g.cemeteries or structures)-, <br /> Nona known. <br /> Do_"dba any on_dto nr nfl-O&courcas of noAto or vibra6w;(y,q.freeway rvi3e h I ant,66- <br /> . heavy a�uipm <br /> None known. <br /> Describe any on-afte or cff-ske sources offght orglam (e.g.pafwpg iot tighung, or fe11&CtWfi'M&refi81s used)- <br /> None known. <br /> Describe any on-site or off-ske svurcos of odor(a,g.e9doulturil wastes); <br /> Possible farming Parbitides&fortilizore, and)dMoVock actilifffat nearby. <br /> Dqschb&any dspia carrant at people that wd be causer by the project(e.g.numbers af p Rapje'housing Links): <br /> None. <br /> A; <br /> 1, th4v Owner/Agent agree, to defend, inderrstdAy, and hold harmless the Couny and its agents, officers and employees <br /> Im, <br /> r,) any claim, action or proceeding against the CwnerlAgentls project <br /> i, funkier, cent/under penalty of perjuryperjurythat I am(check we): I <br /> Legal property ownor(on-nor includes partner, trustee, trustor,or corporate officer)of the propetlV(s) <br /> ;fi voPjad in this application, or <br /> JW Lwo/agent(a&ech proof ofthe owner's consent to the application)of the owner of the property(s) <br /> irvchted in this application and have b000n authorized to file on their behalf, and that the foregoing <br /> appi%cat;cn statements are"7,,e and cornact to the best of my 41UVM*4ga and b&Y@f. <br /> Print Name: Norma J. Norton, Rev. Trst. Signet <br /> z :2� <br /> Print Name: Shirley A. Keltv-Spurgeon Signature: Date: <br /> 10 Print Name: -.,fflon H. &ShWY IA, Schofi*d Signature: Ae <br /> Print Name. Signature: Late: <br /> Print Name: Signature: Date- <br /> Special Notes: <br /> If, addition to owners, notification needs tore mailed to KSN, Inc. at 714 N. Pershing Ave., Stkn., Ca 95203 <br /> and to Ewalon Rench Colony,/.V. clo Michael P. Zagetis 1600 N. Car inter Rd., Suite 8, Mod., CA 95369 <br />