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APPLICATION - U Sr PER. t4 c r <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> 0 <br /> ether ` �R <br /> Describe any itbms of historical-or archaeolo ical interest on sile a cemeteries Of StrUCtufES <br />!I <br /> ©ascribe any.onsite or off-site sources of noise or.vobration e: :freewa noise,heavy equipment,etc. : <br /> qq <br /> Describe an on-site or off-site sources of light of. tare e. .parkln2 lot.li titin ,or reflective materials used): <br /> K ts7!h! a(zVt #Q cq L aT 14414-r r�-1 <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> IN ov5--t R1 A L moo a pte,ocF_sso!z "Ge,-r� <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> NDN F <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. MAO W1 CEO Signature: c �41, Date: �-l-©s" <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F\DEVSW Planning Application FormslSite Approval.(Revised 13--03) Page 5 of 9 <br />