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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4 FILE NUMBER: SA- <br /> - .Other_ - -- <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> None <br /> Describe any on-site or off-site sources of light of glare e. .parking lot li htin ,or reflective materials-used: <br /> None <br /> Describe any on-site or off-site source of odor e. .agriculture[wastes): <br /> I <br /> None <br /> i <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units): <br /> None <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 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: Willis Hill Signature: —I � Date: 07/12/2018 <br /> Print Name: Tiny Hill signature: t Date: 07/12/2018 <br /> Print Name: Louis G. Smith Signature . Date: 07/12/2018 <br /> Print Name: Signature� Date: <br /> Print Name: Signature: Date: <br /> FADEMSVCIPlawdog Application FormslSlle Approval.(Revised 0203.10) Page 6 of 10 <br />