Laserfiche WebLink
t <br /> J, APPLICATION 63 ITE APPROVAL <br /> )O•�f'c0 w F <br /> yr' SAN JOAQUIN COUNTY COMMUNITY.DEVELOPMENT DEPARTMENT <br /> PALE NUMBER: 'SA- <br /> at.'i c osee+ <br /> 2 ' .,qtr ' <br /> SJ,It <br /> Q� Ef. <br /> Describe an ''items of;historical„or aEchaeolo ical.mterest on-site e; cemeteries:o structures <br /> Describe any on site:or off-site sources.of noise or vibration:e: '.freewa9 noise,heavy a u'i rnehf,:etc.): <br /> Describe any on-site or off-site sources of light of glare(e.g.parkin2lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g..agricultural wastes): <br /> Describe any displacement of people that will be caused by the prpject(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 OwnerlAgent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ❑ <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> I �egal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> LL a'`pplication and have been authorized to file on their behalf., and that t regoin application'statements <br /> are true and correct. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F-\DEVSVCIPlanning Application Forms%SiteApproval.(Revised 1-3-03) Page 5 of 9 <br />