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U <br /> of APPLICATION — SITE APPROVAL <br /> y� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ..,, FILE NUMBER: SA- <br /> .-AW <br /> A- <br /> o <br /> Describe any items of historical or archaeological intereston-site_(e.g.cemeteries or structures <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment,etc. : 0 <br /> Describe any on-site or off-site sources of light of glare e`,parking lot lighting,or reflective materials used): <br /> cmv <br /> Describe any on-site or off-site source of odor rictaltural wastes <br /> { <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people, housing units): <br /> 4 <br /> f I. <br /> AUTHORIZATION'SIGNATURES <br /> IONLY 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 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 /> F <br /> Print Name: �M�=S t<Aerheyqs' Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 1 <br /> { <br /> F:IDEVSVC\Planning Application Forms\Site Approval.(Revised"3-04) Page 5 of 9 <br /> I <br />