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May. 26 2006 3: 24PM PROACTIVE PKG. & DISPLAY 9096052950 P, 2 <br /> u _ <br /> APPLICATION - SITE APPROVAL <br /> ■ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r FILE NUMBER: SA- <br /> erikti-'+ <br /> r r <br /> Describes any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Describe any on-site or off-she sources of noise or vibration e. .freeway noise heavy equipment, etc. : _ <br /> &;iv- e, <br /> Describe any on-site or off-site sources of light of glare a. arkinq lot lighting or reflective meterlals usod <br /> Describe any on-site or off-site source of odor e. .agricultural wastes)" <br /> Describe any displacement of people that will be caused by the pro act(e.g.numbers of people housing 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 correct. <br /> Print Name: ^-c. �'�`u-4J.t Signature: Date: S o76 —06C1Print Name: .-3[7 "'� �Cct Sionature: _ Date'. S--(n ^D�&_ <br /> Print Name: Signature: Date: <br /> Print Name: _ _ Signature: _ Date: <br /> Print Name: Signature: Date: <br /> FibrVSVC%plamirg Apolmlion Form Mio Approval.(Revlsed 13-03) Page 5 of 9 <br />