Laserfiche WebLink
DV"� <br /> APPLICATION --- SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> bWJz <br /> Describe any on-s <br /> ite or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> b4 t ks-C, Ft11 /Vt �C G�� 1 <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> bU4 -�e— <br /> Describe any displacement of people that will be caused by the project(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 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: /r /i,, Signature: Date: ,l0 -—/0—,04 <br /> Print Name: d-rK (1B4tOL" Signature: Date: /O^/a <br /> Print Name: gomol WOtUL°Z Signature: Date: <br /> Print Name: C^ A Signature: d�'^� Date: <br /> Print Name: tA. / h L k Signature: Date: <br /> F:UEVSVC\Planning Application Farms\Site Approval.(Revised 13-3) Page 5 of 9 <br />