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psul.. APPLICATION - SITE APPROVAL <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA-- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> N <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc.): <br /> 12>CJN1%- kS a LA-(n -H itsI . iimw- <br /> IY1 <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> l on 5i o <br /> -� r CL 0,+ <br /> Describe any on-site or off-site source of odor(e-g. agricultural wastes): <br /> © t���ff E <br /> Describe any displacement of people that will be caused by the project e. .numbers of people, housing units): <br /> C <br /> AUTHORIZATION SIGNATURES .r—� <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> P-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:�C�L(I�y S CJS 'tel Signature: )c_ Date: <br /> Print Name: Signature: >t Dater_ <br /> ) <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Date: <br /> F%DEVSVC1Planning Application FormsVs,te Approval.(Revised 13-03) Page 5 of 9 <br />