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°p4U1" APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMEN- <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> N A. <br /> Describe any on-site or off-site sources of noise or vibration e. , freeway noise, heavy equipment,etc. : <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. . agricultural wastes): <br /> Describe any dis lacement 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 Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers al <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 statemer <br /> are true and correct. <br /> r�,���ps�� et <br /> Print Name: �i�i�4'P*�S Signature: Z Date: ! l� <br /> Print Name: Clµ L Signature: Date:D <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />