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Z / <br /> SAN JOAQ�IN or N SUE APPROVAL <br /> C0Iltm COMMUNITY OEV"OPMEMT DEPARTMENT <br /> FILE NUMBER: SA <br /> b <br /> Oascrl Ifems of I or' - ire anaa6 e. .oemeteriea or ekudwiks <br /> None Known _ <br /> DssGribe any o"Ite or off-site sources of noise or vibration(e.g,haoway noise,,heavy epuipmenL ekc�: _� _ <br /> Propertv,%mtA M hwa 99—noise from freeway <br /> Describe an on-aft or of-site souros8 of W a lare a. . lot Wag,or reNeptive m g WALV�us <br /> Potential for sarL&yard fighting. No ItahlIN eurmntiv exists. Proposed Uahtlna will be Dern SkY FdordY._____�__��_ <br /> oasodbe WN on-oft or 9941M souroa of e. . rd waste!): <br /> None Known <br /> Oescriba any displacement of people tha:vAa b4 caused by the project(e.g.numbers of people, <br /> None <br /> AUTHORIZATION SIONATU!TS . <br /> ONLY TH4 OWNER OF TAE PROPERTY OR AN AUTHORIZE0 AGENT BtikY FILE AN APPL1CA7101111. <br /> I, the OwnedAgent 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 penally of pedury that I am(check one): <br /> Legal property owner(owner includes,partner, trustee,trustor, or corporate otflcar)of the pn7perty(a) <br /> involved In this application, or <br /> © Legal agent(attach proof of the owner's consent to the application of-the propert)(a involved in this <br /> application and have been authorized to Me on their behalf., and that the foregoing application staterrtents� <br /> are true and correct. <br /> Pnrn Name: Slgnature: _ Data: _ r 1 r 3 <br /> Prim Name: Ma rC I kt. signature: _ t _ Date:—4j14 <br /> 13 <br /> Print Name: Signature: Oate: <br /> Print Name: Signature: r Gate:,__,_,_„ <br /> Print Name: ____� Stgnawra: <br /> F:to EV5VOTL4 lny Apprronticn Famn\9se Approval.(Rs»wd MS-") Page 8 of 9 <br />