Laserfiche WebLink
QViN, <br /> .G APPLICATION SIVE APPROVAL' <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �� - �,..• �� — —FILE NUMBER: SA_.—___—..� <br /> ^— 4�tr[iP�yi <br /> othor <br /> Describe any items of historical or archaeological tnterest on--site_(e.q_cemeteries or structures): <br /> Describe any on-site or-off-site sources of noiso or vibration e.g.freeway noise, heavy equipment,etc.): <br /> �L Z _— RC2 ` ✓I a t � , SI <br /> Describe any on-site or off-site sources of light of glareparkin�l it lighting,or reflective materials used . <br /> Describe any on-site or off-site source of odor(e. , agricultural wastes): _ <br /> .� <br /> iDescribe an isplacement of eo —that will be caused by the project ems -, numbers of people,housing units): <br /> _ _ r � .- -- __ -- — —4I <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, forth , 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 A, t <br /> of the roperty's involved in this <br /> application and have been authorized to file on their b at th oregoing application statements <br /> are true a orrect. <br /> Prirn Name: _Wee Signature: _..___ _� Gate: <br /> Print Name: Signature: — Date: <br /> Print Narne: —------ ----- Signature. ___----- --- _ -- Date: ----- — !i!t <br /> Print Narne: _ -- Signature: -__-- __-- ----_ _ — Date: I� <br /> Print Name: __-- -- Signature: ----- --- --- ----— -- Date: ----,--- —-- <br /> F.DIVSVCPanning Application FJrmsGOe Approvgl.(Revised 1-3-03) Page 5 of 9 <br />