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e ` <br /> r <br /> t <br /> APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMIENT <br /> ;4 <br /> FILE NUMBER: SA- <br /> Y5_ aY � <br /> ���� .�1 t �s.��`.��5`7a� �� <'�.''� -.�+,tfi5 t�f_ sat''yr .. d' �M>,-'�• - - -, ,. <br /> u� r <br /> Describe an �t ii�s.olf.ftisio[Ical or archaeolo ical inferest on�sjte e' .cemeteries or structures): <br /> A/On de 01 <br /> Describe any :site oroff--site sources of noise"or vibration. e: .freeway noise,hea.yy equipment,etc. : <br /> NO 1 e i' e V7 41 .,e,-1 <br /> Describe any on-site or off-site sources of li ht of glare Je.g.parkin lot li htin ,or reflective materials used): <br /> NO h G <br /> Describe an on-site or off-site source of odor(e.g. i ricultural wastes : <br /> Non e <br /> Describe any displace of eo le that will be caused b the ro'ect e. . numbers of eo le,housin units <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/Aggnt'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 /> are true and correct. <br /> EFF L)EIV eP-J Signature: Date: <br /> Print Name: T g <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> F TEVSVcIPlanning Application Fotms\Site Approval.(Revised 1-3-03) Page 5 of 9 <br />