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APPLICATION - SITE APPROVAL <br /> . r SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �' •• FILE NUMBER: SA- <br /> Dascdbe any Items of hislarical or amhanolonfcal Interest on-site e .cemeteries or structures): <br /> None. <br /> Describe any on-slle or off-site sources of nalse or vibration e. .rmeway noise,haM equipment,eta): <br /> None. <br /> Describe my on-site or off-site sources of IrMl of plore(e.g.parking lot fighting,or reflective materials used); <br /> Track and car lights. All parking lot 11ghting vM be shielded with cutoffs). <br /> Describe my on-site or off-site source of odor e. .agricultural wastes): <br /> None. <br /> Describe any displacement of people that will be caused by the project(e.q,numbers of people,housing units <br /> None. <br /> ' AUTHORIZATION SIGNATURES:': '. '.. <br /> ONLY THE OWNER OF THE PROPERTY OR AN"AUTHOR AGENTRAY FILE AN APPLICATION. <br /> 1, 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 propertys Involved In this <br /> t�application and have been authorized to file on their behalf.,and that the foregoing application statements <br /> are true and correct. ee . <br /> Print Name: err Gtu� Signature: Dale: <br /> Print Name: Signature: S Dale: <br /> Print Name: Signature: Date: <br /> Print Name: signature: Data: <br /> Print Name: Signature: Dale• <br /> FADevsv�an,i gApo=flm Fo ,Ma App�d.(Rovam"n M) Page 5 of 9 <br />