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,6 01 : 05P John Taylor YC 1 (530) 671 -5901 <br /> ,/22;05 13:26 FAX 209 942 0 Siegfried Ens tvuu� <br /> APPLICATION - <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT" <br /> FILE NUMBER: XIW ' <br /> fo <br /> eel <br /> Describe an ms of historical or archaooloq cal interest on-silo(9.q.cometecies or stnnctures): __ <br /> None <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,otc.): <br /> None <br /> Descnbe uny on-site or otf-site sources of I ht o1 glare(9.9.paskinglot fighting,or reflective materials usod: <br /> eral yard lig <br /> a <br /> Describe any on-site or off-sffe source of odor(e.g.agricultural wastes): <br /> None <br /> Describe any dis lacemenl or people that will be caused by the project(L-.q-numbers of people.housing units): <br /> None <br /> AUTHORIZATION S.LGNAT.URtS`� ` ;` t <br /> _ aL t .•• <br /> .•. l yklFt0llU�.ER30F T I-IE PROPERTY OR AN.AllTF10RIZED:AGENT MAY FILE; _g7Ab. <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 /> t,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 th application of the property's involved in this <br /> application and have been authorized to file on their b alt.,and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Y L � S Signature: Date: l-z-1-1- Or- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signelure: Date: <br /> FYDEVSVQFinrvnnp Apocalbn Fomm%Usn Perm.(RnVCod K 03-04) Page 5 of 9 <br />