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e <br /> ' - APPLICATION - SITE APPROVAL <br /> -e SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT, <br /> FILLS NUMBER: SA- <br /> E- <br /> ,5''^y. �, LIF. yyiyri _`i v-.Pk <br /> .:. ik .,xas,'-'_h t,a n: ,�_ fit,. I -�"..,''" urc .-( 3 A <• ^ tk.,,.te'r;< r� e iy rf-: s�i` �y "i�LFe t ?'k4 ia'` ,y,g,y ' %, <br /> n .F. ti€ .�•s.ay..n iQtfl@C a ri .c•�+ass 2x;r� �� .. nf, R <br /> Describe any items of historicai.or archaeological interest on-site (e.6.cerrieteries or structures <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc: : <br /> Aele . <br /> Describe anyon-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used : <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): . <br /> F <br /> Describe an displacement of people that will be caused b ro <br /> the 'ect(e.g. numbers of people,housingunits : <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 1 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: Signature: Date: f Q� <br /> Print Name: Q&� fl'NsG YLG Signature: Date: Qom' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVC1Planning Application FormslSite Approval.(Revised 1-3-03) Page 5 of 9 <br />