Laserfiche WebLink
P4U1~•.0 APPLICATION SITE APPROVAL. <br /> _ y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t FILE NUMBER: SA- <br /> Other <br /> A-Vt her <br /> Describe an items of historical or archaeological interest on-site e. .cemeteries or structures : <br /> Describe an on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,eta : <br /> Describe any on-site or off-site sources of light of glare e. . arkin lot Ii htin ,or reflective materials used): <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> Describe an displacement of people that will be caused b the ro'ed e. .numbers of people,housin units : <br /> EE I <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 /> ❑ 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: U '< <'r'J Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F\DEVSVCTIanning Application Forms\Site Approval.(Revised 09-10-08) Page 5 of 9 <br />