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APPLICATION 7SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ``¢i°fF •R��� FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeological interest on-site e. .cemeteries or structures : <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freewaynoise, heavyequipment,etc. : <br /> ✓'� � v r" ryt tn-�" ✓Gc c?�C r� e fc, <br /> Describe an on-site or off-sitesources of light of glare JtcLparking lot lighting,or reflective materials used): <br /> a+r✓l�G U et, 4"55 YQW41, 15 <br /> Describe any on-site or off-site source of odor e. .a dcultural wastes): <br /> `C , <br /> Describe any displacement of PeOlDle that will be caused )y the project(e.g. numbers of 2eople,housing units): <br /> veL-e <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, 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 /> 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: il'�+� �• k�ltl� Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FTEVSVC\Planning Application Forms\Site Approval.(Revised 1-3-03) Page 5 of 9 <br />