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SITE IMPROVEMENT PLAN <br /> n � < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> cP FILE NUMBER: IP- <br /> Existing Roads <br /> Road/Street Name R.O.W.Width I Pavement Width Curb/Gutter Sidewalks <br /> Mountain hose Parkway 1 120 ' 35 ' + 35 ' Yes® No❑ Yes ® No❑ <br /> Yes ❑ No❑ Yes❑ No❑ <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 correct. <br /> Print Name: 1141 le re 0 N i pf-o- Signature: �� Date: Y-6 - 17 <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 Forms\Site Improvement Plan. Page 4 of 9 <br /> (Revised 8-1313) <br />