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APPLICATION — ciITE APPROVAL <br /> r' y <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Imo: <br /> FILE NUMBER: SA- <br /> 4l%PORN _- <br /> } <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> /✓v/ZX <br /> Describe an on-site or off-site sources of noise or vibration e. .freeway noise,heaa a ui ment, etc.): <br /> !y/GIIW(✓ 4 , <br /> Describe an on-site or off-site sources of light of glare(e.g. parkinglot lighting, or reflective materials used): <br /> Describe an on-site or off-site source of odor(e.g. agricultural.wastes): <br /> 0V P= d <br /> Describe an dis lacement of p.npl,that will be caused b the ro'ect e. . numbers of eo le, housin 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: A 3F iS YFW• Signature; <br /> Date: 3 Z S- <<' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> FOEVSVIDTlanning Application Forms\Site Approval.(Revised 13-03) Page 5 of 9 <br />