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A40IN APPLICATION - SITE APPROVAL SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT w: FILE NUMBER: SA- 9�rFORN` Existing Roads Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks '�tV kCt n,A ,. t G rX Yes❑ No t9 Yes❑ No 19�VoLtG Gv�wrh� Yes❑ No❑ Yes❑ No❑ ENVIRONMENTAL INFORMATION USE ADDITIONAL PAPER, IF NECESSARY Water,Drainage and Flooding Describe any areas subject to flooding(include flood depths and flood panel map number): V Describe the current depth of the ground water and depth to potable water: Describe any existing drainage courses or eroded areas on or near the project site(e.g. rivers,creeks, swales or drainage ditches): Land,Land Use and Biota Describe the site's(topography(e.g. land forms,slopes,etc.): �V4 l y v Describe agricultural land that will be lost as a result of the project(type of crops,acres,quality of soil,etc.): Describe any wildlife habitat on-site and species that are of may be present: lit, �- Describe any vegetation on-site by type and extent: tVlei. Air Quality Describe air pollutants that may result from the project(e.g.construction related dust,vehicle trips per day,fire places, incinerators, etc.): Nl;�'Zsz•---' F:\DEVSVC\Planning Application Forms\Sita Approval.(Revised 6-03-04) Page 4 of 9 APPLICATION - SITE APPROVAL o. < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT •. FILE NUMBER: SA- Other Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): C> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment, etc. 1 - lel• 6'UL4r f�S <- r .� - -- - -- Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): DnU4tkt . Describe any on-site or off-site source of odor(e.g.agricultural wastes): K,2-, Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units): l AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. I, further, certify under penalty of perjury that 1 am (check one): Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application, or ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and have been authorized to file on their behalf., and that the foregoing application statements are true and correct. Print Name:\J\\�- t �� (1�C.� t Signature: Date: Print Name: lh11,y4kA Signature: Date: I ZI I Vr� Print Name: Signature: 7 Date: Print Name: Signature: Date: Print Name: Signature: Date: F:0EVSVC\Planning Application Forms\Site Approval.(Revised 6-03-04) Page 5 of 9