Laserfiche WebLink
APPLICATION - SITE APPROVAL <br /> �r� K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: $A- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e. .cemeteries or structures): <br /> Alo..- <br /> Describe any on-site or off-site pources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> Mi411J1.`{ INf�eRt�C V <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> • , S''E.. .G �iC � oVP1r`.� �".,-l�C�� �T Ot-t l.. <br /> wt61 NOT ►1� <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> J t lv— <br /> Describe any displacement of people that will be caused by the project e. .numbers of people,housing units): <br /> &r4- <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 tru/e�and correct.1l� <br /> Print Name: i/r:ni t-�t 6-t�P7-e-� Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ROEVSVMPlanning Applicallon Foms4Sde Approvel.(REVised 02-03-10) Page 5 of 9 <br />