Laserfiche WebLink
v Og4vuly <br /> ,.. .�° APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> <i F' 4 --_------- <br /> Other. <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc. : <br /> I <br /> I <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> No fLEf(,CC-T-1 V 6 Mfl7 Rl�C.S <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> O P0C0L--rURaC- WfteTcS o OK-S <br /> Describe any 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 County arising from the OwnerlAgent'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-(-a#tach-proof-of-the-owneVs consent-to-the-appiication-of-the-property's iriVoI 6d-J 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: f k54it„�1 N - PINTO_ Signature. Date: <br /> -Pint Name: Signature: -----� — —Date: <br /> Print Name: Signature: Date: <br /> iI Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I'MEMMPlanning Application FonnslSlte Approval.{Revised 02-03.70} Page 5 of 9 <br /> 1! <br /> 1 <br />