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APPLICATION - S1 i E APPROVAL <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> EFILE NUMBER: SA- <br /> lar <br /> Describe anY Items of historical or archaeo ical interest on-site(e_q.cemeteries or slnrctures:- <br /> Describe any on-site or of(site sources of noise or vibration(e.g. , M noise,heavy equIpmept,etc.): <br /> Describe any on-site or off-site sources of light of glare e. .pa IqElotlighfing,of reflective materials used: <br /> V-0- <br /> Describe <br /> Describe on-site or off-site source of odor e. . 'wihrraf wastes. <br /> " 0 V"q <br /> Describe any disolecament of people that will be caused by the aro (04,numbers ofpeople,housi units: <br /> tJ 6 <br /> AUTHORVATION 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 County arising from the Owner/Agent's project. <br /> I, furt r, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner includes partner, trustee,trustor, or corporate officer)of theproperty(s) <br /> involved in this application, or <br /> Legal agent(attach proof of the owners 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 /> Nnt Name. Ld-!^)r&Iio Q p7U}t L Signature: <br /> _ Date: 1 . <br /> 'riot Name: Signature: <br /> Date: _ <br /> 'riot Name: Signature; <br /> Date: <br /> 'rant Name: Signature. - <br /> Date: <br /> 'rint Name: Signature: <br /> Date: <br /> nevsvc PJar ,g APWX'.RWP,Fmm ,Sr¢Appmal,f W 02-os-to) Page 5 of <br />