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1 Sep 10 04 10: 59a San Joaquin Ceuntt$ 4683127 <br /> p_ 6 <br /> APPLICATION -:SITE APPROVAL <br /> SAN JOAQ[t1N COUNTY COMMUNITY-DEVELOPMENT DEPART1111ENT <br /> FILE NUMBirt2: SA- <br /> t y r r ti ; <br /> _ _�' .r. . _, .,i . ) r. 1 �~ � fy a,°.y'.i Jr �•d.�ns R,i, � �. �w•LS����,4':Iya:i�i'�S A(yys - <br /> descdbe an items of historical or a aeoloulbai interesCon-site to. .cemelerras ar Rtrumres: <br /> Describe anY onsite or off-site sources of nolle or Vibration to. :fre noise heavya l i mutt,etc. : <br /> Describe any onsite or offsite sources of n ht o! tare e ,22!Vrt lot l' hlin ,or retiacove materials used <br /> 1. <br /> Describe any on-site or off-site sourcrs of odor n. ,a rrcealtural wastes. <br /> 1 <br /> Describe an dls racemenl of eo ie that wilt be caused b the ro eat e. .numbers of Mopla,housin units <br /> iA- <br /> U.THORIZA SON SIG lA7t RAS <br /> ONLY THE OWNER DE THE PROPERTY OR AN AUTHORIZED-AGENT Y. <br /> FlLEAN:A0PLICA11du � <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any cialm. action or proceeding against 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 proal of the owner's consent to the application Of the <br /> Property's <br /> involved in this <br /> application and have been allthortzed to file on their behalf., and that the foregoing spplicat on statements <br /> are true and correct. <br /> PrintHarne. C+ L��LS FaDWI Signature. <br /> Print fame: Da4a:5igrtalure: <br /> Date: <br /> Prins NaRte: Signature: tate' <br /> Print Name: <br /> Signature: Coate: <br /> Print Name'. <br /> Signature: Date: <br /> F;SDEVSVC%Prenning npor,glgn r"0fMs1Sft Apprv„al•Maviscm izinz� <br />