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, ti <br /> z• <br /> APP KATION - SITE APPROVAL-- <br /> SAN JOAQUI4 COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �` • FILE NUMBER: SA- <br /> Other <br /> Describe any items of htst6rica7 or archaeolo q]cal interest'on-site 017.cernqterles or structures <br /> NQNE <br /> Describe any on-site or off-site sources of noise or vibration Ce.g.freeWa noise,'heavy equipment,etc. :. <br /> 721 C r <br /> 200Q7qaI Water TCWrk KIS MPTECKt <br /> Describe'an on-site or off-site sources of light of glafd(d.g. O arkin'`clot li htin , or reflective materials used): <br /> TereNLA i 1 <br /> 1 <br /> Describe any on-site or off-site source of odor(e.g.'a ricultural wastes <br /> Green dippingq <br /> I <br /> Describe any dis lacement of peo0le that will be caused by the project(e,g. numbers of people,housing units): <br /> I <br /> I <br /> AUTHORIZATION SIGNATURES <br /> i <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 County arising from the OwnerlAgent's project. <br /> I, further, certify under. penalty of perjury that I am (check brie): <br /> ❑ Legal property owner (owner=includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application,.or <br /> �j 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: _ Umberto-Valdez Signature: <br /> Print Name: —J-yxuda_DeJgtjidice Signature, <br /> Date: <br /> Print Name: _Signature: 11 Date: <br /> Print;name: Signature: Date; <br /> Print Name: - Signature: Date; <br /> i <br /> I <br /> PMEMCIPlanningAppllcadon Forms)SlMApproval.(Revised 02.03-10) page 5 Of 9 t <br />