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y ` <br /> .o APPLICATION — SITE APPROVAL <br /> Z i�lhl� 2� <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> �fFO <br /> Odwr <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): None <br /> Describe any on-site or off-site sources of noise or vibration(e,q.freeway noise, heavy equipment, etc. : Traffic noise from <br /> Escalon-Bellota Road <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): None <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): Cattle ranch south of property. <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people,housing units):None <br /> AlJ HORI,�+.A It7N SIGNA,T:U FS <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHOP490 AGENT MAY FILE AN APPUOATION. <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 /> Tl 0 2 13 �n <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FIOEMCWIanning Application FormslSlte Approval.(Revised 02-o3-10) Page 5 of 9 <br />