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�S Ap.0 i ty - <br /> • APPLICATIOt SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNfTY DEVELOPMENT DEPARTMENT <br /> T . r''•�P <br /> FILE NUMBER: SA- <br /> .. <br /> y <br /> Describe any items of historical or archaeolo ilial interest on-site (e.g.cemeteries or structures): None <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freeway noise, heayy a ui men#, etc. : Some not se <br /> from Huller Equipment when operating <br /> Describe an on-site or-off-site sources of ii ht of glare(t_q. lot lighting,or reflective materials used : None <br /> Des ' <br /> cube an on-site or off-si#e source of <br /> odor e. , a riculturalwastes : None <br /> Describe any displacement of oeople that will be caused by the pLoject e. . numbers of people,housing units): None <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, 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 Keen authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> i <br /> Print Name: Vitoaaro J� 7-22-05 <br /> Signature: ,vim - �-- pate: <br /> Print Name: Signature, Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> FADEVSVCIPianninpApplication Forms\Siie Approval.(Revised 1-3-03) Page 5 of 9 <br />