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APPLICATION - SITE APPROVAL <br /> SAN JOACUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER, SA- <br /> Other <br /> Describe any Items of histoncal orarcriaeoirigirtai interest on-site e. .cemetenes or structures): /U o,u z <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,hea equipment,etc. : tir E Av <br /> Describe any on-site or off-site sources of light of glare e. parking lot lighting,or reflective materials used): NZriG <br /> Describe any on-site or off-site source of odor te.g.a ncWtural wastes): kj 8 N <br /> Describe any displacement of people that will be caused by the project(e.g. numbam of people, housing units)i V!V L <br /> j 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 County arising from the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> I <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: 1 7 ` I ✓ `f- �t'�— ignatur L. / v��Date �d ZC t <br /> Print Name. Signature- Date: <br /> Print Name. Signature: Date: <br /> Print Name,. Signature: Date: <br /> Pnnt Na": _. . Signature' Date: <br /> FIDEVSVOIPIanning Applkatlon Fortes\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />