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s �t APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .,r PILE NUMBER: SA- <br /> Other <br /> Descibe an items of historical or archaeological interest on-site. e. .,emetenes or stn Jctures): p <br /> o17 <br /> Descibe any on-site or off-ste sources of noise or vibration:e. .free%ay coise. heavy equipment.etc.is <br /> E in <br /> Desc be anV onaota or off-site sources of light of giare (e.o.parking bi 1, htin ,or:effective materials usedl: <br /> � r <br /> i <br /> Desuibe any on-sae or off-site source of odor(e.g.agricultural wastes): <br /> QI <br /> Describe any disDlacement Df people that aaii be caused by the tonaject leg. numbers of people. housi units): <br /> lvdoe, <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORtZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents. .officers and <br /> emplove-es from any claim, action or proceeding against the County arising from the OwneriAgent's project. <br /> I. further, certify under penalty of perjury that I am (check one): <br /> [t/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 owners 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: J.T. Ross, Vicerest a Lure: <br /> Print Na :meConstruction & Envtromel wl j' Date: <br /> Print Name: S)gnaturs: Date: <br /> Print Name; Signature: Date: _ <br /> Print Name: Signature: Date: <br /> r:.DevsvCvm„w,e a�x�:k,,,F rsa Av Al.tAe+lsae 02-01 i0) Page 5 of Q <br /> iE <br />