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a` <br /> °PaUiN APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �" %coaHp FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeolo ical interest on-site (e.g.cemeteries or structures <br /> Describe an on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy equipment, etc. <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used <br /> Describe any on-site or off-site source of odor e. .agricultural wastes <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 /> l 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 /> Print Name: SJZo-�^ 2 C t1Ew� Signature: Z— Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.0EVSVC\Plannmq Application Forms\Site Approval.(Revised 1-3-03) Page 5 of 9 <br />