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pUlry <br /> APPLICATION - SITE APPROVAL <br /> T: Z <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> cltoaN <br /> » Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> /ID <br /> Describe any on-site or off--site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> /':'vt�� �Y-L�3 �G•.y�/r �1 S L%'V '`�G/ZQ.I' v l f� � ��� �'� <br /> Describe any on-site o off-site source of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> 1t r��rn o.P ' Co <br /> Describe any on-site or off-site source of odor(e.,q. agricultural wastes): <br /> 11-111100 <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 /> 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 Owner/Agent's project. <br /> I, f4irther, 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 1W((A 6»LSSignatu q I Date: <br /> Print Name: Signature: Date: <br /> 1 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSVOPlanning Application Forms\Site Approval.(Revised 1-3-03) Page 5 of 9 <br />