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SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />items of historical or archaeological interest <br />FILE NUMBER: SA - <br />ries or structures <br />II Describe any on-site or off-site sources of noise or vibration (e.. freeway noise heavy equipment etc.): <br />Ij Some freeway noise from I-5; some farm equipment noise <br />Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): <br />None <br />Describe any on-site or off-site source of odor (e.g. agricultural wastes <br />Describe any displacement o> people that will be caused by the project (e.g. numbers of people, housing units): <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: Donald W. 01 i Ver <br />Print Name: <br />Print Name: <br />Print Name: <br />Print Name: <br />Signature: ( �"° �, <br />Signature: <br />Date: 12/15/05 <br />Date: <br />Signature: <br />Date: <br />Signature: <br />Date: <br />Signature: <br />Date: <br />FADEVSMPlanning Application Forms\Site Approval. (Revised 6-03-04) Page 5 of 9 <br />