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APPLICATION `LITE APPROVAL <br /> H: :< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . <br /> • FILE NUMBER: SA- <br /> 11 <br /> A- <br /> x gy P }rajT�l"M���`���� <br /> .rhh:''3-"�Sy', kti:,:.-7s <br /> ;.Describe an items of.histoncal.-or archaeolo icalJnferest on-site. e_ cern etenes or--structures <br /> Describe ah ;an-site oe off-site`sources of noise prvibratlon e. .freewa 6611, hea equip, fTti". tc <br /> Describe any on-site or off-site.sources of light of glare(e.g.parking lot lighting,or re#lective materials used).- . <br /> Describe any on-site-or off-site source of odor e. .agricultural wastes): <br /> fi <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people,housing units): <br /> AUTHORIZATION:SIGNATURES <br /> ONLY THE OWNER OF,THE PROPERTY OR AN.AUTHORIZED AGENTMAY 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 /> s <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner towner 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: . yIre� J2zJ Signature: Date:c�12 1o_O5' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F OEVSVOPianning Application FyrmslSite Approval.(Revised 1-0-03) Page 5 of 9 <br />