Laserfiche WebLink
APPLICATION - SITE APPROVAL <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NUMBER: SA- <br /> <br />Other <br />Describe any items of historical or archaeologjcal interest on-site (e.g. cemeteries or structures): <br />ij 0 <br />Describe any any on-site or off-site sources of noise or vibration (p.g• freeway noise, heavy equipment, etc.): <br />C C)4..s2.--- <br />Describe any on-site or off-site sources of light of glare (e.g. parking lot lighting, or reflective materials used): <br />isi V \•-•-ce.._ <br />Describe any on-site or off-site source of odor (e.g. agricultural wastes): <br />\-; 0 <br />Describe any displacement of people that will be caused by the project (e.g. numbers of people, housing units); <br />1,..) <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 />E Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br />involved in this application, or <br />E. 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: 00.--€.04 5 l'A g ,i.s0.0\.0....-.. Signature: ... Date: ,C) <br />'\ Print Name: Signature: \ --\---.._ Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />F:\DEVSVC1Planning Application Forrns\Site Approval. (Revised 02-03-10) Page 5 of 9