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APPLICATION - SITE APPROVAL <br /> `h SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • �'p(�F .• FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe any on-site or off-site Sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> f <br /> Describe an on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used <br /> - <br /> Describe any on-site or off-site <br /> source of odor e. .a dcultural wastes): <br /> Ni \ <br /> Describe an dis lacement of eo le that w 11 be caused b the roject e. . numbers of people,housing units): <br /> AUTHORIZATION SIGNATURES <br /> OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 'ONLYTHE <br /> 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 County arising from 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: aZ!ai� F w•. ver^ Signature: - Date: 51 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> Pdnt Name: Signature: Date: <br /> FADEMC\Plannirg Application FonnslSite Approval.(Revised 02-03-10) Page 5 of 9 <br />