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APPLICATION -SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> q .._.;.... :" FILE NUMBER: SA- <br /> (I[ORt? <br /> ------ Other <br /> Describe an items of historical or archaeological interest on-site(e.g. cemeteries or structures): <br /> e <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise hea a ui ment, et e.): <br /> Describe any on-site o off-site source of li In of are e. parking lot lighting, or reflective materials used): <br /> 6 G o <br /> CJ <br /> Describe any on-site or off-site source of o or(e.g. agricultural wastes): <br /> 6.tl� <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> dAt <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, 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 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: L - Signature: Date: 5 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F1DEVSVCWIanning Application Forms\Site Approval.(Revised"-03) Page 5 of 9 <br />