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APV1_ICA!ION = 1'G APPROVAL SAN JOAQOIN CCQNTY COMMUNITY❑EVEI.OPMENT DEPARTM ENT 1 F to UMBER: SA- 13 ® 0 1 1 eeacrl Items or h or efNm I I M oterom on$le e. .oemebmies a vvudurea r Nona Known Dascnbe am owaite or ol• ite aourcee of noise arvibration .liseymy noise,heavyMy mti& PrWeVVYFe hwa 99—noise from freewa Deacribe an on eito ar 011-2110 SOUIM Of ROM Of 91sre e. .karWris tat fighting,or raeeellve materials us : Potential for samrity yaut lighling. Nollatiting u(Igntly.074ta. Proposed U htin wlif be Oar&S LflWdl _ Describe my 0"Ke ar e-eite source Of e. :. douttural Wastes): None Known Describe any dlapJacemantofao to The:writ biA oaueed by the arclact e. .numbers of eo houa:sa mu)i. None �~ ` AUTH0PJZAtT1.0NI :5[dN TURESm . ONLY THR OWNER OF TME PAOPFRTtf ORAN'AUTHORIZEO AGENT PJAY FILE AN APLt..1VAT.1gt I, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and its agents, oflikers afud employees from any claim,action or proceeding against the OwneNAgenVs project t,further, certify under penalty of perjury that I am(check one): Legal property owner(owner includes partner, trustee,trustor, or corporate off ar)of the proparty(s) involved in this application, or Q Legal agent(attach proof of the owner's consent to the application of-tha property's Involved in thla application and have been authorized to fila on their behalf.,and that the f®regolrtg appilcatlon staterliantsl are true and correct. P+tm Name: 41t _ rloejZ Signature: ,.� Data: _ it r.P Peint Name: Marc ;