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u` APPLICATION SITE APPROVAL <br /> H: :< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Qther. <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> or1le . <br /> i <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heayy equipment,etc. : <br /> I ✓/Y1 � �r� Wl��'t'f" ✓q G�G�5 �7tC. <br /> E <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> mvq u n �e s w-e►� �'s can cl►'f o h,ed v /.' Lig-, <br /> Describe an on-site or off-site source of odor e. .a ricultural wastes): <br /> Ayx--[ . <br /> 1 Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> art•e. <br /> AUTHORIZATION SIGNATURES <br /> E <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 /> € 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 /> 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 /> I are true and correct. <br /> LN <br /> ' J .A n <br /> Print Name: 1,1 i �l.W�'� Signature: Date: <br /> { <br /> Print Name: Signature: Date: <br /> k Print Name: Signature: Date: <br /> f <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ` RTEMC1Planning AppSication FormslSite Approval.(Revised 1-3-03) Page 5 of 9 <br /> t <br /> i <br />