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I <br /> I a�qur <br /> APPLICATION SITE APPROVAL <br /> .� SAN JOAQUIN COUNTY"COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4• :6 0 <br /> FILE NUMBER: SA- <br /> .7— .777777777. <br /> Other <br /> FDascriberns of historical or archaeolo ical interest on--site e. .cemeterlesorstructures : <br /> armhouse built in 1926-garagelbarn <br /> Deseribs an on-site or ofrr-sitesources of noise or vibration e. .freewa noise hea a ui ment,etc. : <br /> NIA <br /> VDescribean on-site or offsite sources of ll ht of lare e. arkein lot li htin ,or reflective materials used : <br /> LDe.sGiribean on-site or offsite source of odor a, :a ricultural wastes; <br /> NIA , <br /> i <br /> Describe anY displacement of eo le that will be caused by tha pra'eet e. , numbers of peoj2la,housing units); <br /> N/A <br /> i <br /> AUTHORIZATI <br />. I <br /> ONLY THE C)'NEk 60 THE"Ir 1kQVERTY QR AN AU-'14[3PfZElJ AG'ENT MAY FILE AN APPLICATION. <br /> i <br /> 1, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, act!on or proceeding against the County arising from the Owner/Agent's project. i <br /> i <br /> I,further, certify under penalty of perjury that I am (check one): <br /> I�Legal property owner(owner includes partner, trustee,trustor., or corporate officer)of the property(s) <br /> involved in this application, or <br /> i <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this i <br /> application and have been authorized to file on their behalf., and that the foregoing application statements I <br /> are true and correct. <br /> Print Namelba � .6 n r� Signature: Date` 1 _ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name., � <br /> Signature: <br /> I <br /> F_WEvsvc+Pianning Application Fo-msl,gte Approval.(Revisod 02-03-1 of Page 5 of 9 f <br /> i <br />