Laserfiche WebLink
APPLICATION - SITE APPROVAL <br /> { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •., - ;c FILE NUMBER: SA- <br /> i <br /> 4�1F0�� <br /> Other <br /> Describe any items of historical or archaeological interest on-site e.g.cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> None <br /> Describe any on-site or off-site sources of li ht of glare(e.g.parkinglot lighting,or reflective materials used): <br /> None <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people, housing units); <br /> None <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, fu r, 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: Signature: Af- Date: O <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVS=Planning Application FoanslSite Approval.(Revised 6-03-04) Page 5 of 9 <br />