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APPLICATION - SITE APPROVAL <br /> ' Y j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> tzgJns*N%J FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> None. <br /> Describe any on-site or off-site sources of noise or vibration(e-g-freeway noise, heavy equipment,etc_): <br /> None. <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> None. <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> None. <br /> Describe any displacement of people that will be caused by the project(e.g_numbers of people, housing unrts) <br /> None. <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 County arising from 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 applicati n of the property's involved in this <br /> application and have been authorized to file on their behalf., d that the foregoing application statements <br /> are true and correct. <br /> Print Name: �`f `� —� t C`�`' Signature: 'L Date: �= l <br /> Print Name: Signatu Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> POEVSVC.t'lanning Application Forms\Sde Approval.(Re%gsed 012-03-10) Page 5 of 9 <br />