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SW13 attachment(1700F 2338) <br /> APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any Items of historical or archaeological interest on-site - .remeteries or structures): <br /> ivpv <br /> Describe any on-site or off-elle sources of noiseetc.): <br /> lk-:i be t�,A n 4 Sk� 61e J ou,� <br /> 10L.a. <br /> Describe any on-site or off-site sources of light of glare(e.g,parking kWt 19 <br /> Describe an on-site or off-site source of odor(e.g.Nricultural wastesi <br /> Describe any displacement of IIeo21e that will be caused by theprdec�'e. numbers of le,�houain �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 County arising from the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> ONLY <br /> THE OWN <br /> Owner/Agent <br /> I rth- ne /Agen <br /> employees <br /> w s from <br /> a <br /> 1, fu 0ye , c f n <br /> her, certify <br /> under <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: P ),, I"n, Signature: Date:_01- 2.0 - <br /> Print Name: Signature: Date: <br /> PrintName: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FI,DEVSVC\Mannie� ANIic3Lon FOMskBileApPrOW1.iR imd 02-03-I0) Page 5 of 9 <br /> hftPs:/Jmail-attachrTwV,goWleuser Gmtent.corrVattachnent/.kn=2&ilc--egfcd8f5G6&4e v=att&th=1413cbf7aoeb9284&atd--0.4&disp=irdine8safe=1&zy6sadue=A 112 <br />