Laserfiche WebLink
"4u�l..�a APPLICATION - SITE APPROVAL <br /> T <br /> N SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> q.;.. , ., P FILE NUMBER: SA- <br /> <«oR�i <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc. : <br /> M <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting, or reflective materials used): <br /> / <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): <br /> 1 -4 <br /> Describe any displacement of people that will be caused by the project e. . numbers of people,housing units): <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 County arising from 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: L�Cf �ctY �� dV��r'��Signature: Date: <br /> C <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSMPlanning Application FonnslSite Approval.(Revised 02-03-10) Page 6 of 10 <br />