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APPLICATION SITE APPRO A-C . ` <br /> 7.•�..y�t'•AG <br /> I' 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): Fjo <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc. : <br /> Describe any on-site or off-site sources of light of glare e. parking lot lighting,or reflective materials used): <br /> p <br /> Describe any on-site or off-site source of odor(e.g.a ricuitural wastes <br /> Describe any displacement of peopie that will be caused by the promect(e.g.numbers of people, housing units): to <br /> a <br /> AUTHORIZATION SIGNATURES <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 /> X 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 Mame:' ' U lT C�Y Signature: Date: <br /> Print Name: natur Date: <br /> Print Name: -11 v �^ c Signature: Date: 1e <br /> O4 N4 Signature: Date: r ' - /* Z <br /> Print Name: � : � 9 <br /> Print Name:61Pg412 _e3v-Wry-u eiS Signature:.. Date: --16 -09 <br /> F:IDEVSVC91anning Application FormsSSite Approval-(Revised 1-3-03) Page 5 of 9 <br />