Laserfiche WebLink
�p4u N APPLICATION - SITE APPROVAL <br /> { ' y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c•ro`p. FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise, heayy a ui ment, etc.): <br /> > <br /> Describe any on-site or off-site sources of light of glare e.g.parking lot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any displacement of people that will be caused by the pEoject e. .numbers of people, housing units): <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 truce and correct. <br /> Print Name: l/T�-B._rrS h� P �Va, Signature: _ Date: J 2. <br /> Print Name: �rnAa�l�1tL Signature: �1 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F1DEVSVC\PIannin9 Application Foms\Site Approval.(Revis d 02-0310) Page 5 of 9 <br /> it <br />