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r PQM 4. c APPLICATION —­SITE APPROVAL <br /> y y' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> '60' <br /> c. W..�tiY�.-T�s'r'��b r�n.- "'' .h,.., ri',�;�- �:O�I7,�1; {,��;* .�t,�.k45,}�i -.. xr e'4.,.�+�''y✓�-�4�� ; �} ,��.� "�r�i--y�y"i��+y��v.,�� y Cr <br /> Describe anyitems of historical or archaeological interest on-site e: .cernete.ries or structures <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heayy equipment,etc.): <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.a ricultural'wastes : <br /> If <br /> Describe any displacement of people that will be caused by the p9ject(e.g. numbers of peoplehousing units): <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED 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 /> employees from any claim, action or proceeding against the Owner/Agent's pro_jest. <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 /> a are true and correct. <br /> Print Name. Ed&J,_,t rd F V o Vef'.' TY. Signature: f t-ei4ct Date: 10 J T <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVOPlanning Application Formslsite Approval.(Revised 1-0-03) Page 5 of 9 <br />