Laserfiche WebLink
F'F'LIC:A 1 IVN I t AVVMUVAL <br /> A <br /> SAN JOAQUIN COUNTY COMMUNI �EVELOPMENT DEPARTMENT= <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures). <br /> CN� <br /> Describe any on-site or off-site sources of noise or vibration (e.g, freeway noise,heavy equipment,etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot fi htin , or reflective materials used): <br /> r]C� ( i..tl�9—T H AL.{)�i�f{�, � <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> its _ Lam' <br /> r <br /> Describe any displacement of people that will be caused by the project e. . numbers of people, housing 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 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 /> 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: L Signature: Date: Z �� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:1t3EVSVC1Planning Application FormslSite Approval.(Revised 02-03-10) Page 5 of 9 <br />