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OUiN <br /> APPLICATION — SITE APPROVAL <br /> Z: s <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `ii) akN:° FILE NUMBER: SA- <br /> Fr <br /> Otherk <br /> Describe an items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> 110/1! <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> Haat <br /> Describe any on-site or off-site sources of light of glare (e.g. parking lot lighting, or reflective materials used): <br /> 4W <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> /i1;//C <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> /10Q1 <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 /> C� <br /> Print Name �-:^dr €�,L11 C -14 C �� Signatur _ e���- ",-vt-f,/'1 � Dater <br /> Print Name: S R OD F S 1 EOL . Signature: � Fw✓ --- -s-f Date: 12- <br /> I b I bS <br /> Print Name: Signature: _ rvJ//-�-cyy-�i i�JeoE�/ Date: -� <br /> Print Name: A V TAI, S - �Dt_ Signature: ��LoL Date: 2 b <br /> Print Name: Signature: Date: <br /> F.\DEVSVC\Pianning Application Fo"sVSile Approval.(Revised 1-3-03) Page 5 of 9 <br />