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OUN <br /> C, <br /> ° APPLICATION - 81TE APPROVAL <br /> / 2 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT ' <br /> cgC.FORa�P FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> U' lic/ <br /> D�escribe an on-site or off-site sources of noise or vibration(e.g.freewaynoise, heavyequipment, etc. : <br /> 1 u,i ryu ,INCL d I S t,fid h, j c !/l& -h,,u t vs .J-eD aal eS5 <br /> De"s`cfi�e"at'i n-slte or -slfe sources of�li hi of tare e. arkin to li htin , or reflective materials used): <br /> Pi Yp <br /> U l.�V <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> OVI L, <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> 1 — e is yo 0 ' - <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED 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. // � <br /> Print Name: mu L/1, ' Signature: l ' , /I_A ItZWRW Date: /—/?--0 7 <br /> Print Name: Signature: f�rn�J Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 11 1 <br /> F:\DEVSVC\Planning Application Forms\Site Approval.(Revised 1-3-03) Page 5 of 9 <br />