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Ma�j .13 04 09: 32a San 'caquin Count� 46831271 P. 5 <br /> pMrN. I A I <br /> -rATIONI _ ,qITI7 A` <br /> APPI I <br /> :iFf <br /> SA,N J0 AQ U 1.1114 <br /> DEVELOPMENT DEPARTMENT <br /> FH E NI 'PP. tZA- <br /> Other <br /> I Describe anyitems of historical or archaeological interest on-site lke.q.cemeteries orstructuresl. <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freewa,�npis,,�hea e�ui ,,nt, <br /> Z2 <br /> Describe. on-site or off-site sources of light of glare(e-g.parking lot liqhting,or reflective materials used): <br /> Describe anv on-site or off-site source of odor(e.Q.agricultural wastes): <br /> II <br /> Describe any rspiacerrlent of people that will be caused bX the proect(e.g_ numbers of people,housing units): <br /> dZ1,X <br /> jl ii <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> 1, 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 /> li <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. III <br /> Print Narne:ZAV4�,/I, _7_�a r Avkn __ Signature: '245��_ 3, L_ Date:24y4v <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I Print Name: Signature: <br /> FMEVSVC\Planning Application Forms\Siie Approval.(Revised 1-3-03) Page 5 of 9 <br />