Laserfiche WebLink
°p.. ..,N APPLICATION - SITE APPROVAL <br /> a. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "v ......•• FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> � <br /> Describe an on-site or off-site sources noise or vibration e. .freeway noise, heavy a ui ment, etc.): <br /> Describe an on-site or off-site sources of light of glare e. . parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): Pa s c Y <br /> =Describe an dis emeroject(e.g. numbers of people, housingunits): <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 /> ❑ 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: © W ELL tom, HTff� Signature: Date: <br /> Print Name: � Y � �_� Signature: <br /> Date: �S O � <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F]DEVSVOPIanning Application Foms�Site Approval.(Revised 1-3-03) Page 5 of 9 <br />