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JUN-18-2010 11:00 From: To:209� r55102 P.212 <br /> APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> "fr't - <br /> Other <br /> Describe&MY Items of historical or archaeolo teal interest on-site*0 cemeteries or Structures): <br /> None Known <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc.: <br /> Pro erl fronts Highway 99—noise from freeway <br /> Describe any onsite or off-site sources of light of glare Ie,g,parkhq lot fighting,or reflective materials used): <br /> Potential for securi and lighting No 1,ghfing wrrenfty exists. <br /> Describe any on-site or off-site source of odor e: -agricultural wastes): <br /> None Known <br /> Describe any displacement of peoplO that will be caused b the proie4i e. .numbers of people,housing units): <br /> None <br /> AUTHORIZATION SIGNATURES <br /> rowner/Agent <br /> WNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> gent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> any claim, action or proceeding against the Owner/Agent's project. <br /> fy under penalty of perjury that I am (check one)erty 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 fie on their behalf., and that the foregoing application statements <br /> are true and correct. r/ <br /> Print Name, Signature: '�-�� Dale: 3 <br /> Print Name: Signature: Dew <br /> Print Name: Signature, Date- <br /> Print Name- Signature. Date: <br /> Print Name: Signature: Date: <br /> F\DEVsvCNWnn,na Apoution FomulSda AOV'a'al tRsvlsetl 6-63-04) Page 5 of 9 <br />