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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: SA- <br /> _o epi <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> NONE <br /> Describe any on-site or off-site sources of noise or vibration(e.g. freeway noise, heavy equipment, etc.): <br /> STATE HIGHWAY ROUTE 120 <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting, or reflective materials used): <br /> NONE KNOWN <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> NONE <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> NONE <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, grantor, 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 <br /> statements are true and correct. <br /> r <br /> Print Name: ARVIN J. BOERSMA,TRUSTEE Signature: gr1Y Date: IL9-2J=Q(y <br /> Print Name: THERESA V. BOERSMA, TRUSTEE Signature: """"� y' ed�Date: <br /> 6 �s7�C1� \ -f _ /d -2 <br /> Print Name: v( 1 C7�t� �ud�rSigna �4w( QQ rod-= Date: Y—>f <br /> RIPON FARM SER IC , <br /> Pnnt Name: - . AZ F/ —/ Signature: Date: w <br /> ON F R ERVICE rt <br /> Print Name: Signature. Date: <br /> R0EVSVS\Planning Applicatlon Fonns\SBe Approval(Revised 6-03-04) Page 4 of 4 2006-48 SA <br />