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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.g. cemeteries or structures): <br /> Describe an on-site or off-site sauces of noise or vibration e. .freewaynoise,heavyequipment,etc. : <br /> C 6 <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e. .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 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 owners 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/amend correct. <br /> Print Name: d//e1�' ��r,'•`�--, Signature: Date: <br /> Print Name: <br /> Signature: Date:___ <br /> Print Name: Signature: Date: _ <br /> Print Name: Signature:ature: Date:____ <br /> Print Name: <br /> Signature: Date:____ <br /> F.\DEVSVC`Planning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />