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APPLICATION - SITE APPROVAL <br /> N: <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> None <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting, or reflective materials used): <br /> I <br /> -site or off-site source of odor e. . a ricultural wastes : <br /> lacement of eo le that will be caused b the roject e. . numbers of eo le,housin units : <br /> LLLAUTHORIZATION 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 employees from any claim, <br /> 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 /> Z Legal property owner(owner includes partner, trustee,grantor, or corporate officer)of the property(s)involved in this <br /> application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to fl a on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: Xg0_4WS' >: AAf r^ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Application Forms\Site Approval(Rev,02-03-10) Page 6 of 9 <br />