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06/27/07 13:56 FAX 209 942 0214 Siegfried Eng Z005 <br /> APPLICATION - SITE APPROVAL <br /> Q' `t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c <br /> FILE NUMBER: SA- <br /> .p: <br /> Describe any items of historical or archaeolo ical Interest on-site(e.g.cemeterles or structures): <br /> None known. <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise•heavy equipment etc. <br /> Interstate Hi hNay 5. <br /> r <br /> e an on-site or off-site sources of I' ht of lare e. . arkl lot Ii htin ,or reflective materials used:e an on-sila or off-site source of odor a. .a ricultural wastes: <br /> Describe any displacement of people that will be caused by the prolect e. .numbers of people,housing units): <br /> NIA <br /> 'PiW T+.S,i.0_4 P• Sh / �ti'i'R ".!, t ''{ <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/Agents project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal properly 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 N��a,,,m,,��e: ICJc(, � F1l iZGT"61.J Signature: Dele: .27 7 <br /> Print ra%: �� VHu£Y B2o P4a zlf lgnature: Dale: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F 0EVSVC{P1anr4ng Application Forms\Site Approval(Revised 6O3N) Page 5 of 9 <br />