Laserfiche WebLink
APPLICATION ''SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical-or archaeological interest on-site(e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e,g,freeway noise, heayy equipment, etc. : <br /> o fo <br /> I <br /> I <br /> i <br /> Describe any on-site or off-site sources of light of glare(e.2.parkinglot lighting,or reflective materials used): <br /> 1,1 6df1rJ > 6 r CL 8 0-n p1q-c <br /> o d - Dvw c.-I -r <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): <br /> tj O0-1 15- <br /> Describe an dis lacement of eo le that will be caused b the ro'ect e. . numbers of eo le, housin units <br /> -J � <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 <br /> I, further, certify under penalty of perjury that f 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: ✓ 11 2 • �/C7 �Svi.1 Signature: I�-� Z Date: <br /> f <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVC\Planning Application Forms\Site Approval.(Revised 1-3-03) Page 5 of 9 <br />