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APPLICATION = SITE APPROVAL <br /> z: <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> F OR. <br /> Other <br /> Describe any items of historical or archaeological interest on-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. : <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): <br /> Describe an <br /> displacement of people that will be caused b the project e. . numbers of people, housingunits): <br /> AA <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> 9-fegal 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: 5/r2 L.— ID a r y Signature: cg Date: /U-21—v e <br /> Print Name: S-flyo,"- s S /Dn,— v Signature: o A A Date: /°'21—d y <br /> Print Name: Signature: Dale: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.\DEVSVC\Planning Application Forms\Site Approval.(Revised t-3-03) Page 5 of 9 <br />