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4 yl APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .. I FILE NUMBER: SA- <br /> I f;f Other.- <br /> Describe, n items of histdrical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe n on-site or offsite sources of noise or vibration e. .freeway noise heavy a ui menl,etc,): <br /> fi U'T 1@9 TW or AI01W01Z UIt3F'mAj Ory T?W)CR +DriiL'i <br /> errJ G #4V-e- . S UI I I K n11J1AJ1ZW -h tilt' itri' <br /> Describe n on-site or off- ite sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> t 1 W,i I 13e +r,w heli , r Of— A4; <br /> ti ((fes{ iGz a/ shwo s op wix1ilro.6. `Fn r M/ <br /> pliw <br /> Descn a onsn ith oro • i e so�Rg( d r e, a hcultural wastes: <br /> aloµ� <br /> I <br /> Describe an dis face ant of people that w(II be caused by the project(e.q.numbers of People,housing units): 1 <br /> AUTHORIZATION SIGNATURES !? <br /> ONLYITHE OWNERIOF:THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the O�ener/Agent agree, to defend, indemnify, and hold harmless the County and its agents, offfeers and <br /> employ as from any cliAm, action or proceeding against the County arising from 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 /> El Legal agent(attact proof of the owner's consent to the application of the property's involved in this <br /> application and,ha a been authorized to file on their behalf,, and that the foregoing application Statements <br /> are tue and correct. <br /> p� r <br /> Print Name /p f u d 2'Y r L signature: �liLc,tG C -�L-GG Date: 3­116 `� E' <br /> Print Name Signature: Date: <br /> Print Name tt <br /> Signature: Date- <br /> Print Name Signature: Date: <br /> Print Name, Signature: Date: <br /> F.0EVWC"ann1�9 APPrin4an Forth Wit.App�vN.(Rav6e 02-0340) Page 5 of 9 <br />