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-E-;` APPLICATION - SITE 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 feq. eometeries or structures): <br /> j D✓F <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment, etc. : <br /> 5 <br /> —3 r <br /> Describe any on-site or off-site sources of light of glare a. .2arking lot lighting.or reflective materials used): <br /> 1—/11fr'5 SfZ -7-.— FK <br /> Descnbe any on-site or off-site source of odor(e.g.a riculturai wastes): <br /> D <br /> Describe any displacement of people that will be caused I)y the prolect e. .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/Agents project- <br /> 1, <br /> rojectI, 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 t the foregoing application statements <br /> are true and correct <br /> Print Nance: � <br /> ��s��i +4"/ . Signature: Dale: <br /> Print Name: ,J��hiFpl� L/7Y_.t,✓T Signature: Date: O <br /> 6-; <br /> Print Name: /(///�IH�Ir- r i'N 7-- Signa DBIe; D <br /> Print Name: Signature: Date: <br /> Print dtim <br /> Srgnawre: <br /> •Dare: <br /> r 4Yri� l k".� <br /> Z0/Z0 39vd 3dV0SQ?JVH3AIiV3N0 9998ZE860Z 90:EI 8002/LI140 <br />