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y� ra 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.e. , cemeteries or structures): 1 <br /> r\10 Y\ <br /> Describe)any on-site or off-site sources of noise or vibration (e.g.freeway noise, hea.yy equipment,etc. : <br /> 1'� ms2wwt vti u wa a l' L <br /> Describe any on-site or off-site sources of light of glare e.g. parkinglot lighting,or reflective materials used)- <br /> Describe <br /> sed :Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> hoh2, <br /> I <br /> Describe any displacement of people that will be caused by the project(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 /> I, the OwnerlAgent 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 /> [0-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 Nam <br /> Signature: Date: —O <br /> Print Nam$: Signature: Date: <br /> Print NaMq,, Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name, Signature: Date: <br /> FADEVSV90anning Application Forms\Site Approval.(Revised 1-3-6j Page 5 of 9 <br />