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APPLICATION -'SITE APPROVAL <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NUMBER: SA - <br />Other <br />MS <br />of historical or archaeolo ical interest on-site (e.g. cemeteries or structures): <br />d� <br />e or off-site sources of noise or vibration e.. freewaynoise heavyequipment, etc. <br />A/'Th7f - T3'n 4 I^i A e, ✓ �- <br />�n .9 _r �► I -t r+n r.� e or off-site sources of li ht of lare e.. arkin lot li htin , or reflective materials used : <br />s,r ? (po Lvopr PoLF L,' lrs ALo)-a t7 +ve�A <br />�(F a <br />Describe any on-site or off-site source of odor e.. agricultural wastes): <br />0 n 5r0rr ap rl.o <br />Describe any displacement of people that will be caused by the prodect (e.g. numbers of people, housing units): <br />0 A.) <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, further, certify under penalty of perjury that I am (check one): <br />[�Z 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: E'C.`na�*J Signature: Date:/O-oiB^OL) <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />F'.0EVSVOPlanning Application Fonns4SRe Approval. (Revised 1-3-03) Page 5 of 9 <br />