Laserfiche WebLink
ti,7l4kf�'� APPLICATION - SITE APPROVAL <br /> Y <br /> '� SAN JQA62UIN COUNTY COMMUNITY dEWELOPMEhiT DEPARTMENT <br /> rte, FILE NUMBER: SA- <br /> Cfl�er <br /> Describe any ftems d Nstoricel ar arch aea kcal Iniersel on-ails(e.q-oemeleriea or smrAuraa: <br /> None- <br /> Describe any on-site or off-site sources of noise ar vibration(s_q.freeway noise heavy squipmeM eta : <br /> None <br /> Describe any on-site or off-site sources of W of gIELre (o.g_paAcing tat Wng.a raUctivs materials u <br /> Parking lot lighting - will be equipped with sheilding to cut glare <br /> and contain lighting on-site. <br /> Describe any on-arta ar df-alto source of odor e. _apricultimal wastes): <br /> None <br /> Describe any d1splwarnent of people that will be caused by the project a. _numbers d people,ho" unita : <br /> None <br /> AUTHORIZATION SIGNATUFM <br /> ONLY THE OWNER OF THE PROPERTY OR AN A.UTHORI2ED AO ENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnity, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Ownsr/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 /> irrwived 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 fibs on their behalf., and that the foregoing application statements <br /> ane true and correct. r� y� <br /> Print Name:/Y�1 LL/A �l r�L Signature: /'C Date: ��O 7��� <br /> Print Name: Signature: Date: <br /> Print Noma: Signature: Date: <br /> Print Name: Signature: Dane: <br /> Print Name: Signature: Date: <br /> F QEVSVC'1?Mn0V Mdk�lb.+r-OOWSOA k0pr Wel,IRe.+t 48'04-oM1l Page 5 of 9 <br />