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APPLICATION SITE APPROVAL <br /> �. •.oG <br /> .< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> 10 <br /> Describe any items of historical or archaeological interest on-site e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy ui ment,etc.): <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> ",.re v lr3� ��. L-►-�. `� V ul �l V>t+T- I.57 t V� <br /> Describe an on-site or off-site source of odor(e.g.agricultural wastes): <br /> r�ar� <br /> Describe any displacement of people that will be caused by the pTject(e.g.numbers of eo le,h ousing 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 and <br /> employees from any claim, action or proceeding against 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 /> eegal 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. q �[ <br /> Print Name: Ill fi1 T— (-a& Signature: Date: { Zu <br /> Print Name: Signature: Date: <br /> Print Name, Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVCIPlanning Application'Forms\Site Approval.(Revised 1-3-03) Page's of 9 <br />