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r <br /> r• <br /> - APPL`1CA1 11-TI1 .ON - SITE APPROVAL <br /> ' { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT v <br /> -FILE-NUMBER:- SA= --- - — <br /> y -.�. un- rW0thne <br /> er.�.: <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment,etc.): <br /> /.,/o nl e. ' f4i./olr1,lPl <br /> Describe any on-site or off-site sources of light of glare e. .parkilot-lighting, or reflective materials used): <br /> /�o/�Lr✓ >Kiti/o/.�C� <br /> _ escna an p n=sif-or off=site so/o�rce�—of�ad__ . - riculttiral was es----- <br /> Ohl� �h1CI�L <br /> --Describe a is lacement-of eo p le-that Will be-caused-by-the-oro'ect e . umbersvf eo le;housin -units: - - <br /> o <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, o`fficer's and <br /> employees from any claim, action or proceeding against the County arising from 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 /> Print Name: (S( . [KaL Signature: Dater <br /> Print Name:_ -_ Signature: Date: <br /> - PrintYY gnato <br /> Print Name_; -„ Signature.- - _- - Date' - - - <br /> Print Name: Sighatute: •. a Rafe ; <br /> F:IDEVSVOPlanning Appricabon Fonns'SHe Approval.(Revised 02-03-10) Page.6-of10 . <br />