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Ju 1-14`=05 06 a 27P Musca Family Ol iivga P.04 <br /> APPLICATION -- SITE APPROVAL <br /> W JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> f=its niuMOM: SA <br /> fI ' <br /> 0"W <br /> C]efde anyitems of lei a_wdwedbgmW irrtererrt a.g_oarrrafarim or strppuras- <br /> Kano that are knaWI <br /> r <br /> Desc f*My o"ite ar aifmite sourms of noise or aibMinn(wg.fteeyAw noise,hwwy equipment,etr~ <br /> Desoto on-site or"o abum s of Wt of&rq e. .poft lit Kofto.or r+etiective rrortedek used): <br /> Demme my on4ft or off-site sMMM of attare. Wrw mrsstes: <br /> Active a tin have i tbe-ing handled. <br /> Demme aodrreent of PWI it;at vAl be sedthe e. .num berg of mils <br /> None f <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER QF(THE PRQPERTY OR AN A>tJTHt)1>IOM AGENT MAY FILE AN APPI_IGA'I OrA. <br /> 1, the Owner/Agit agrala,I Wdated, inderrueify. and hold harmless the County and its agents, officers and <br /> emptpy�tom any dah; ,actitm or proceWing against t#w Owner/Agent's Project. <br /> I,further,certify under pemlty of pef)ury that i am(chedt onto)- <br /> ❑ Legal property owner(owner includes parbw, hudee, trustor, or corporate officer)of the p rty(s) <br /> invohoed in this applirban,or <br /> Legal agent(attach proof of the earner's wnsent to the application of the property's Involved in this <br /> appka m and have bibeen authortzed to file on their behalf.,and that the forgoing application stmerrtertts <br /> are two and correct. <br /> " rgnatema: Date: . <br /> P&d Name_ .. �.� _ ftnahtre: ��..... Date- <br /> Print Name: _ �: Date, <br /> P"P ww. si b"' Date.• <br /> PAM Name: SignstErce- Dace: <br /> l <br /> F DEWMFU n Ons npprrauon Fwm&Wft pp'-'4-(ReoFsed 64m") Page 5 of 9 <br /> ji <br /> 3 i <br />