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AF FLIUA I WN - ,I I t HF VHL)VHL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeological interest on-site e. .cemeteries or structures <br /> None <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise, heayy a ui ment, etc.): <br /> Freeway noise, planted trees as sound barrier <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting, or reflective materials used): <br /> arkin lot li hts <br /> Describe an on-site or off-site source of odor e. .agricultural wastes): <br /> None <br /> Describe an dis lacement of eo le that will be caused b theproject(e.g. numbers of people, housing units): <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 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: Robert R. Pimentel Signature: Date: A/_ Z� lT <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br />