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if <br /> APPLICATIONS-' SITE APPROVAL <br /> PRIVATE RIGHT OF WAY - ANTIQUATED SUBDIVISION <br /> .cf 8 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> '0 <br /> A- <br /> ? F r <br /> Describe any itemsof historical or archaeoio ical Interest on-site e. ..cemeteries or structures)- <br /> Describe <br /> tructures :Describe agy on-site or off-site sources of noise or vibration e. .freeway noise heov <br /> y equipment,etc. <br /> +Q <br /> Describe any on-site or off-site sources of light of gWre e. .Larking lot 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 b the project e. .numbers of people, housing units): <br /> �E <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 /> 1, 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 correct. <br /> Print Name: Fa2ISignature: Date:_3r--O� <br /> Print Name: LAt;oA V_, 6�2 Linyi-1 Signature, Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:%DEVSVC\Planning Application Forms\Site Approval) Page 5 of 7 <br /> Private Right of W By.(Revised4-2.43 <br />