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pOU rN <br /> APPLICATION — S-fTE 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.g. cemeteries or structures): <br /> L) <br /> Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy equipment, etc. : <br /> km �C- Vy-w (AV , btk - 1 Y d u- CLt <br /> l l ui&UA• 'YA++ <br /> Descri e h o - t e or 5-Wit"es r es 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 /> DOX2 On 3 )j;� L , <br /> Describe any <br /> n displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> lly LCA <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 /> SQ n cl 57-19 <br /> Print Name: vgrp tt� Signature: te: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> OEVSVQPIanning Application FonnslSite Approval. (Revised 1-3-03) Page 5 of 9 <br />