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� y 4 <br /> F 1 <br /> APPLICATION -- SITE APPROVAL <br /> : sn SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ;A FILE NUMBER: SA- <br /> 0 <br /> Other <br /> Describe an items:of historical or archaeological interest on-site e. .cemeteries or structures : <br /> Describe any on-site or offsite sources of noise or vibration(e.g-freeway noise heayy equipment,etc. : �tl <br /> -A Q <br /> Describe any on-site or off-site sources of light of glare Ce._g._pArking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor e. . agricultural wastes <br /> i <br /> Describe any displacement of peophe that will be caused by theproject(e.g. numbers of people, housing 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 /> G <br /> [Legal property owner towner 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 a <br /> are true and correct. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FMEVS=Planning Application FormsGte Approval.(Revised 05-11.09) Page 5 of 9 <br />