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FROM ^ (FRI)HOV 0 2009 9 lST. 9:01 lNo. 7613900167 P 6 <br /> LIIUZ(L [1707 ZLe;UL, L17y—tJe4 1312 UtuKHrr Ut.YtLU�' ,Y 1. r-ti4uc Cab <br /> s <br /> APPLICATION -- SITE APPROVAL <br /> 9 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> •� MEN Lar.q :{.i 'Yy SwF <br /> Describe any Items of historical or archaeologl6al interest on-site e. .cemeteries or structures): <br /> NIA <br /> Describe FIn on-site or off-site sources of noise or vi bratlon e. .freeway noise heavy eq ui ment etc.): <br /> Describe any on-site or off-slte sources of liqbt of glare .e. .parking lot I!ghting,or reflective materials used): <br /> l Describe any on-site or qff-site source of odor(b.j3.a ricultural wastes): <br /> 7escribe any displacement of Mple that will be caused by the PMJect e: .numbers of p2ople,housing units); <br /> the Owner/Agent agree, to defend, indemnify, and hold harmless the County.and its agents, officers and <br /> employeos from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I am (check one): <br /> [A Lega'property owner(owner includes partner, trustee, trustor, or corporate officer)of the property(s) <br /> j involved in this application, or <br /> (� Lega; 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 tree and correct. <br /> Pint Name: _rURLS11 z�•t� � Signatu Date: vu 0 V <br /> Pint Name: Signature: late: <br /> Pint Name: Signature: Date: <br /> Pint Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 1=:1DEvsvClPIanning AppAeatton FormMft Approvai.(Revlaed 05.11-08) Page 6 of 9 <br />