Laserfiche WebLink
APPLICATION SITE APPROVAL <br /> L .:...�r.... '.� <br /> J. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ..-.-_ .... FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): <br /> 4� <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> 'E. � - <br /> Describe any on-site or off-site sources of light of glare e.q. parkinglot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> I Describe any displacement of people that will be caused by the project(e.2. numbers of people, housin d units): <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 /> 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 cor ct. <br /> Sa � <br /> Print Name: Signature: Date: 3r <br /> Print Name: �OF�7�� 3cty4�; 7 -Signature: Date: p <br /> /01 <br /> Print Name: Signature., Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 17MEVSMPlanning Application Forms\Site Approval.(Revised 6-03-04) Page 5 of 9 <br />