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APPLICATION --SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> 7 <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc): <br /> 2 <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 /> 0 13 Pi <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units : <br /> 0 Qi <br /> AUTHORIZATION SIGNATURES <br /> rFONL:Y::THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> yees 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 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 and correct. <br /> Print Name: + ord Te 6=1yr Signature: �///.....yyy������` ��� Date: <br /> Print Name: &OL& t M Signature: {�J -�J� .SL�AJ-'rY�, Date: o2 <br /> Print Name: PeAro <br /> /^� LL D� 1� Signature; ( � oft/G�" Date: <br /> Print Name: SW4 M Signalurw_s`yi , &1&/Zd ���iyJ� Date: <br /> A/ <br /> Print Name: Signature: _ Date: <br /> FMEVSVC\Planning Application Forms\Site Approval.(Revised 09-10-08) Page 5 of 9 <br />