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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: SA- <br /> 7any <br /> s to o ra h Use and Biota <br /> p g p y (e.g, land forms, slopes, etc.):tive) flat <br /> ral land that will be lost as a result of the project(type of crops,acres,quality of soil,etc) <br /> elife habitat on-site and species that are or may be present: <br /> mon birds and rodents <br /> Describe any vegetation on-site by type and extent: <br /> L none <br /> Air Ouali <br /> =.jrp011ulantsat may result from the project(e.g. construction related dust,vehicle trips per day,fire places, incinerators,etc.): <br /> n associated with the construction of an office -Qhnn and arkin lot <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> none known <br /> Other(Continued) <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise,heavy equipment,etc.): <br /> loaders and trucks <br /> Describe any on-site or off-site sources of light glare(e.g.parking lot lighting or reflective materials used): <br /> none <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> none <br /> =anynt of people that will be caused by the project(e.g.numbers of people, housing units,etc.): <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 employees <br /> 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 /> LJ Legal property owner (owner includes partner, trustee, grantor or corporate officer) of the property(s) involved <br /> n this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property(s) involved iJan"d <br /> and have been authorized to file on their behalf and that the foregoing application statements a <br /> correct. <br /> JJ <br /> Print Name: . - Signature:r 5y' .�: y DatePrint NameSignature i`_; � -- <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Prim Name: Signature: <br /> Date <br /> F:DEVSVC Planning Application Forms/ <br /> Site Approval <br /> (Revised os-gs-oa) Page 3 of 3 <br /> Job No 2004-110 <br />