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OUlry - 1r <br /> '° APPLICATION - SITE APPROVAL <br /> z: 1 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .�42,pop <br /> po R�\e. FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeolo ical interest on-site e.q. cemeteries or structures): <br /> 1�1b�4 <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy a ui ment, etc.): <br /> uflN� <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): <br /> o I <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes : <br /> M <br /> Describe any displacement of people that will be caused by the project(e.g. 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 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 /> ❑ 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 at the foregoing application statements <br /> are true and correct. <br /> 'rint Name: Signature: Date: <br /> Tint Name: n,.t L Q V Signature: C Date: <br /> Tint Name: Signature: Date: <br /> 'rint Name: Signature: Date: <br /> Tint Name: Signature: Date: <br /> ]EVSVCWIanniog Application ForrnslSite Approval.(Revised 1.3-03) Page 5 of 9 <br />