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pouriv APPLICATION - SITE APPR-OVAL SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT Q1F R� FILE NUMBER: SA- ...:.' Vie.: .. .. _. .t iwo�..,.s S",r ' �° e 5. wr..•�r l�fli@�;auit r r,L' �4 4 y? �'� r �*�� '�4 � �z`yy,A,�r'�� "1 tf.`ti, Describe an items of historical o.r archaeolo ical rnterest on=site e.. _cemeteries or structures. I --------------- �t7v�s G Describe an on-site or off-site sources of noise or vibration e. freewa noise flea e ui meet etc. Describe an on-site or off-site sources of light ofglare' e. . Earking lot li Ming,or reflective materials used Describe an on-site,or off-site source of odor e. , a riculturaf wastes am C r Describe any die lacement of eo le that will be caused by the project(e.g. of e o le, housin units 0acvC /AUT[- ORIZA1 ION S1GNATURt'S ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN A►PPLIICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. 1, further, certify under penalty of perjury that i am (check one): ❑ Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application, or k Q�Legal agent (attach proof of the owner's consent to the application of the property's involved application and have been authorized to file on their behalf., and that the are true and correct. foregoing application s attements i Print Name: Roma _JV J Signature: Print Name: Date: lg CD Signature: Print Name: Date: Signature: Print Name: ----_� Date: Signature: Print Mame: --� Date: Signature: -- _ Date: i 1C)EVSVCIPIanning Application Forms\3i1e Approval.(Revised 1-3-o3) Page 5 Of 9