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v <br /> s <br /> APPLICATION - <br /> w. SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 9�jco AK� <br /> FILE NUMBER: SA- <br /> Describe an items of historical or archaeolo ical interest on-site(a.-cemeteries or structures : None <br /> Describe an on-site or off-site sources of noise or vibration (e-.-freeway noise,heavy equipment, etc. : Traffic noise from <br /> Escalon-Bellota Road <br /> Describe an on-site or off-site sources of light of glare(e.Q.parkinglot lighting. or reflective materials used : None <br /> Describe any on-site or off-site source of odor e. . agricultural Wastes2: Cattle ranch south of 2roperty. <br /> Describe an displacement of people that will be caused by the project(e.g. numbers of people. housing units). None <br /> AUTHORIZATIOfd 619 Ots <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHOR,1910D AGP—NT MAY FILE AN FA170AT'ON. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agfficers andemployees from any claim, action or proceeding against the County arising from the Owner/ 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 /> J$ 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 /> �' On' Si nature: Date: Z /3 <br /> Print Name: g <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature Dale: <br /> F OEVEiMPlannmg Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />