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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> �tfiOR <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment, etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> II_ <br /> Describe any displacement of people that will be caused by the pr6iect(e.g. numbers of eo le, housing units): <br /> Pr <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, offers and <br /> ermployees from any claim, action or-proceeding against the County arising from the OwneriAgent'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 fie on their behalf., a d that the foregoing application-statements <br /> are true and correct. <br /> Print Name: ����+� �" "�` Signature: Date: d = <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 6 of 10 <br />