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y <br /> Wil. • • 71' <br /> APPLICATION - SITE APPROVAL <br /> c / s <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> �iFa�� <br /> Other: <br /> Describe any items of historical or archaeological interest on-site Le.g.cemeteries or structures): S T�R-40— G--i <br /> (� Co LTi �a 3E <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : T� <br /> BAST ij! ��ESS <br /> Describe any on-site or off-site sources of light of glare e. .parking lot li htin ,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.2.agricultural wastes): <br /> Describe any displacement of people that will be caused by the project e. . numbers of eeople,housing units): C <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 /> 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:2�G ao&LAN :S 2 L Signature:DO Date- S za /0 <br /> Print Name: Signature: Date: <br /> Print name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RVEVSMPtanning Application FormslSite Approval.(Revised 02-03-10) Page 5 of 9 <br />