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>° APPLICATION - SITE APPROVAL <br /> ry SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> F <br /> a „ .. <br /> r c F+ryi.y ] , <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 heavy equipment,etc.): <br /> Describe any on-site or off-site sources of li ht of glare e. .parking lot II htln •or reflective materials used),agAini <br /> Describe any on-site or off-site source of odor e. .a dcultural wastes): <br /> VAa�4 -to Q&A,- fiartataly'Aa Uwe <br /> Describe any displacement of people that will be caused by the project e. .numbers of people,housin units <br /> kfirl <br /> AUTHQF41� StIaA�A'ME <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHOAMen 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 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. G AN4j�Llf} uN�S U.S,> ,yc <br /> Print Name: Signature• Date: <br /> Print Name: Signature: _ 4-95gg2X&2— !' ate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: - Date: <br /> Print Name: Signature: Date: <br /> MEMCIPlanninp Appkati n FOnnstSit9 Approval.(Revised 6-0309) Page 5 of 9 <br />