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Rt!:y <br /> APPLICATION - SITL,, kPPROVAL <br /> ♦d SAN.IDAGUIr,'COUNTY C0IWUfjry DEVELoFvEw DEPmrrmEkT <br /> •�'ry v'�' FILE NUMBER: SA. . <br /> other <br /> D�re,n Thurrs Mtirefoye,lwarcl+a icel interest on•eile e. -cematnties orsWchrres; <br /> AIC ni, <br /> Dprnba orraTe croiF-elle sources of or vibratbn 8Q.tree,, no <br /> se hMvy nUjPM&hL etc. <br /> i(1+Csf'I"i�'i ',.Y 'r,.r iG l�rL�.✓t �¢ <br /> Destrlba Dome m oR she,ourcas of 1 of glare e. arking lot Aphunn,or raflective mal,rlals <br /> Describe otr-0pe or oR_Site sounm of odor Lea.noticultraw wastes,11 <br /> rJ C PIE_ <br /> Describe a ix dl h, ent of o that will be musedyrs <br /> til i.n e. .rxunbers of a housi uNts <br /> AUTHORI7RTIOitI SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPUCATIDN. <br /> 1, the Owner/Agent agree, to Cidefend,Indemnify, and hold harmless the Countyand its agent,officers and <br /> employees from any claim,, on or proceeding against the Owner/Agent's project. <br /> 1,further,certify under penalty of perjury that 12m (check one): <br /> (� Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the p <br /> involved in this application,or roperiy(s) <br /> Legal agent(attach proof of the owner's consent to the application of the propertys involved in this <br /> aPPFcatimh and have been authorized to file on their behalf_,and that the foregoing application statements <br /> are true and coned. <br /> i r Signature: Data .1 <br /> Rist Name: SL <br /> Signature: Dais: <br /> Print Noma <br /> Signahae: Dale: <br /> Print Name: Sigwtoo,! <br /> Date <br /> ['tad Name: <br /> Slgrh,fure: Date: <br /> Owner or Authortred Agent: <br /> X <br /> P int Name Date: <br /> X <br /> Tltte: <br /> �-iignature— <br /> F:�otvsv�v�r,;,e AaWceaon FDm %Nn Apuom.caeA„a 1Sd3) Pa9e 6ofg <br />