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D� N <br /> 'ems APPLICATION — SITE APPROVAL', <br /> m :< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • c.- P FILE NUMBER:SA-- <br /> Other <br /> FDescribeems of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> O� <br /> Describe an on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment, etc. : <br /> V <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 /> Describe any displacement of people that will be caused by the project(e.g. numbers of people,housing units): <br /> c% ev <br /> X. - '� t: `-`�'Se� �.:-f-.asp -f a. 3 #•5. 9 ,a, ° -s3.� ry <br /> {OI�I ffiNE O�IYI�E_Ft�F�-t-tE PR{PER <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 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: `�/U /, � 5'ei d/ ;Signature: Date P <br /> Print Name: e: Da <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\)EvsvC\Planning Application Forms\Use Permit.(Revised 02-03-10) Page 5 of 9 <br />