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4511n � <br /> APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> eat Fo r; FILE NUMBER: SA- <br /> - 'OYtier � <br /> Describe an items of historical or archaeological interest on-site(e._Q.cemeteries or structures): <br /> None <br /> Describe an on-site or off-site sources of noise or vibration(e.g-freeway noise, heavy equipment. etc. : •i <br /> Moving trucks <br /> Describe an on-site or off-site sources of li ht of tare e. . parking lot lighting,or reflective materials used): <br /> None <br /> Describe any on-site or off-site source of odor(e-q.agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project e. .numbers of people, housin units): <br /> None <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 /> El 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 /> c3ozTe r G:�P;� 9 <br /> Print Name: Perm-Schceenetieh Signature: - Date: ----2-C-S - <br /> Vtce resident,General Manager <br /> Print Name: -r - ri Signature: L��. / Date: Z 2 -G j <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: _ Signature: Date: <br /> 1DEVSVQPIanning Applirafion Fom s5Zite Approval.(Revised 1-3-03) Page 5 of 9 <br />