Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
[2JVVJ/VV.-I <br /> x � A <br /> APPLICATION SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I <br /> ,Fare`} FJ,LE NUMBER: SA- <br /> les3c: <br /> y i'..�qL Vr Sir'•, tii:° 1,.rt'i ' ..yr�'�r'r T�� .jj � '?,i'�sir :i - :}{e an Items of hlstorlcal or archaeolo Ical Interest on-site e. .cemeterles or structures : <br /> Ae an on-site or off-site sources of noise or vibratlon e, , freewe noise, heav a ul ment etc. <br /> ansportation Noise (Off—Site from Highway 88) <br /> e an on-site or off-91te sources of li ht of tare e. par lot lighting,or reflecfvo materials used <br /> N/A <br /> i <br /> Describe any on-slte or off-site source of odor(e.g. agricultural wastes): <br /> N/A <br /> I <br /> Describe an dle lacement of oo to that will be caused by the project e. . numbers of pOople, housingunits <br /> N/A <br /> AUTHORIZATION SIGNATURC S <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENY MAY FILE AN APPLICATION, <br /> I <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 /> f, further, certify under penalty of perjury that I am (check one): <br /> II ' <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ <br /> Legal agent (attach g g proof of the owner's consent to the <br /> application of the <br /> property's s involved in this <br /> application <br /> and have been authorize <br /> d to ills on ►.heir behalf., and that the foregoing application statements <br /> are true and correct. <br /> !! II .t <br /> Print Name: Wivid Mor;)�e Slpneturo: DOZ� Date: 6//.9/06 <br /> PrIrrTNarrr til r' gnature Date: AfL� — <br /> Print Name: Signature: Date: <br /> Print Name; Signature: Date: <br /> ¢rin[Name: Signature: Date: <br /> NOEVSVCUvlsr+ninp AppkeUon Fnrrmal.Slle Approval.(Revised 1.3-03) Page 5 of 9 <br /> 1 ,r, r' - <br />