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ur44 e APPLICATION — SITE APPROVAL <br /> •z <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other`-. <br /> Describe any Items of hlslorical or archaeological Interest on-slie e. .cemeteries or structures): <br /> None. <br /> Describe any or"Ile or ntf-site sources of noise ar vibrellon lea.freeway noise,hee a ul menl.elc : <br /> None. <br /> Describe mY en-site ar oR-site sources of light of qlare(9.11.Parldn9 lot 0 htln ,Dr reflective materials used); <br /> Truck and car li hts. All parking lot li hg tin will be shielded with cutoffs). <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> None. <br /> Describe an dl lecement of people that will be caused by the project(e.g.numbers of people,housing units): <br /> None_ <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY.FILE AN APPLICATION- <br /> 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 /> ILegal agent(attach proof of the owner's consent to the application of the property's Involved In this <br /> YYY X11 application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. p <br /> Print Name: erl Q. � Signature: Date=� <br /> Print Name: Signalure: Date: <br /> Print Name: Signature: Dale: <br /> Print Name: - Signature: Dale: <br /> Print Name: Signal— Dare: <br /> FsoevSv 1� �roNe Apa�ope Fprm M.A,.w .rRo�sn3-oat Page 5of9 <br />