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APPLICATION - SITE APPROVAL <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): — fjA <br /> 7�s•„ibe any on-site or off-site sources of noise or vibration (e.g.freeaway noise, heavy equipment, etc.): <br /> the ro o &d 5:}a W,11 Ie 1- r-- ed 04 afi <br /> Describe any on-site or off-site sources of light of glare e. . parking lot fighting,or reflective materials used): —NIA <br /> Describe an 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 County arising from 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 that the foregoing application statements <br /> are true d correct. <br /> Print Name: /Signature: ff— Date: <br /> ' Print Name: _ a�gnaiure: Case: i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVOPlanning Appllr tion Fom i%Ske Approval. (Revised 02-03-10) Page 5 of 9 <br />