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APPLICATION--i SITE APPROVAL <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> rq`.FP I FILE NUMBER: SA- <br /> 60 <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. . cemeteries or structures): <br /> ONS <br /> Describe an on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> PAssING. Ve:"\Ct es ON li4v4y, 45$ <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): <br /> FX►�. S�� �R ri- ri�nNC-t ' Ra posEp oil- 5 Cris_ <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes); <br /> n <br /> Ply 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 /> 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 /> 1, further, certify under penalty of perjury that I am (check one): <br /> u 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 corrrecctt.,,,1 t�r� <br /> Print Name: teh� ` `c`.veyr'�r�S Signature: Date: /o S <br /> PrintName:G tWILit--9 1�US Signature: Date: ,2� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSVC"anning Application Forms\Site Approval.(Revised 13-03) Page 5 of 9 <br />