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APPLICA TION") SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> .� . <br /> Y SAN JOAQUlN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I <br /> A111'1'lOR TI SIGNATURES. ,a'_ <br /> I <br /> ONLY THE OVYNFR dF THF PROPERTY OR AN ALITHQRIWD AGENT MAY:F1LP AN APPLICATION. <br /> 1,the Owner/Agent agree,to defend,Ind mnlf and h <br /> o! <br /> Y d <br /> ha <br /> or armless ss <br /> o th <br /> teed! a County u <br /> P again nt and nd <br /> s 1 <br /> 9 9 t the Owner/ nt s project~ Y is agents,officers and employees frau any claim,action <br /> 1,further, certify under p alty of perjury that l am(check one): <br /> Legal Property owner(owner includes partner, <br /> application, or trustee,trustor,or corporate officer)of the property(s)Involved in this <br /> Leg <br /> O agent(attach proof of the owner' <br /> haveave been authorized to file on ths consent to the application of the property's invol <br /> elr behalf.,and that the foregoing application staved in this application and <br /> been <br /> are true and correct. <br /> Print Name: _ <br /> Signature: <br /> Print Name: Data: SF 3 <br /> Sign tur <br /> Print Name: Date: ���� <br /> S re: <br /> Print Name; Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Date: <br /> a <br /> r <br /> t <br /> i <br />, <br /> I <br />