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APPLICATION SITE APPROVAL <br /> `•�` .4 1r. � -\ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '. <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> Al0d4E <br /> Describe any on-sits or oft-site sources of noise 6r vibration e. .fremyay noise, heavy equipment, etc. <br /> 1vaN G <br /> Describe any on-site or oh-site sources of light of glare e. .parking lot hUhting, or reflective materials usedl: <br /> NO&C <br /> Describe anY on-site or off-site source of odor e. . agricultural wastes): <br /> Describe any displacement of pwple that will he.mused by the project (e.g.numbers of people,housing units): <br /> N/ <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 t 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 be alf., an t at the foregoing application statements <br /> are true and correct. <br /> Print Name: ', I Signature: _ - ate: �- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: ._ Date: <br /> Print Name: Signature: _ Date: <br /> Print Name. Signature Date: <br /> c1.)EV5VCWIannhg Aopbution FormslSne Approval (Revised 1-3-D3) Page of <br />