Laserfiche WebLink
°p4u1N APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY - ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> C%FORH <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. . cemeteries or structures : <br /> none <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment, etc. <br /> none <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting, or reflective materials used): <br /> none <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> none <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> none <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 County arising from the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <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 <br /> /rcorrect. <br /> 0 21A <br /> Print Name: L�/JI/K I"I�t. /T-rr Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Farms\Sic Approval) Page 5 of 7 <br /> Private Right of Way.(Revised 5-11 09 <br />