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s APPLICATION SITE APPROVAL <br /> 1Y' I <br /> W° SAN JOAQUIN COUNT'COMMUNITY rEV=LO PMENT DEPARTMENT <br /> Deschbr,any items of 1*100C3i or archasologic I interest on-site e - <br /> { A ccmeterres or <br /> None <br /> l .>escnne any en site or oft-site srxirces of noise or vibration(o.g.freeway noise,h""equipment.etc.): <br /> None <br /> Dascribe any or-srte or off-site sourC�of light of glare(e.g. parking lot lighting, or reflective materials used); <br /> None <br /> ve,C`ibe any or'sire or cdf-adq source of odor(e.g.39lieVltgral wastes): <br /> $ee attaChed exhibit No.3 - <br /> Dey<;nha any displacement of people that will be caused by iha pro)ar:t(a p. numbers of pecole,housing un tsi. <br /> No people will of displaced. <br /> 7�UTHQRIZAT60N 51GNATU;RES <br /> ONLY THF-OWNER QFTht�PRQP..,ERN!?F?'AN AUTHOAIZED,Ad,ENT h9AY FILE ASI;APPLICATION. <br /> the Owner/Agent agree, to defend, indemnity, and hold harmless the County and its agents, officers and <br /> employe65 frau any claim, action or proceeding against the Owner/Agent's project. <br /> it.rther certify, under penalty of perjury, that I am (check one). <br /> Legal property owner (owner includes partner, trustee, grantor, or corporate of loer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application <br /> 9Iatcrnenrs are true and correct. <br /> ,.'.;n• Vama T q- �^ry'�j•� ��--�-'� Signature' ' /, Dale. / 1+~ <br /> Priv Varne_ JOU - 5l7� / 'iF9/�! / �f g f C4 cF-' -'.�,•�` <br /> P,4,t Vanu:• Signature: date: <br /> P,:i. 4tnid Signaturo: Date: <br /> I <br /> h.I P+!ni 14ame <br /> Signature: Date_ <br /> "CEV%VC Ffanriny.4;rgwein:rFMASne Rpprv+,1.Q JV1Ji$V002.00•tol Page 4 o 4 ' `Lola-rzs sirs apprnVa�.nrc <br />