Laserfiche WebLink
l <br /> pUly. APPLICATION - SITE APPROVAL <br /> r 2 <br /> � c. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other q1 <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> j Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc. : <br /> I <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes).- <br /> Describe <br /> astes.- <br /> Describe any dis iacement of people that will be caused by the promect(e._q-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 true and correct. !� <br /> Print Name. � <br /> ff�t I fav'` 1 f X_ Signature: ate: I� �' U <br /> Print Name: S UsCkw L 11,01-YL Signature: I—J=� Date: eL-& U <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> PNOEVSMPlanning Application FonnslS@e Approval.(Rovised 05-11-09) Page 5 of 9 <br />