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r } <br /> e4U`" APPLICATION — SITE APPROVAL <br /> a' a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N; K <br /> i <br /> • FILE NUMBER: SA- <br /> tiFORN <br /> Other <br /> pon-siteor <br /> of historical or archaeological interest on-site e. .cemeteries or structures : <br /> Dte or off-site sources of noise or vibration e. .freewa noise,hea a ui ment etc.o17ite or off-site sources of li ht of lare e. . arkn lot li htin ,or reflective materials use/I�ite or off-site source of odor e. .agricultural wastes); <br /> O °�— <br /> Describe any dis lacement of eo le that will be caused by the ro'ect e. . numbers of people,housing units <br /> Dh <br /> AUTHORIZATION SIGNATURES <br /> F <br /> E OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> r/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> rom any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> 1,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 statements <br /> this <br /> application and have been authorized to file on their behalf., and that the foregoing app <br /> are true and correct. <br /> Print Name: 4/"D L, <br /> 4e Signature: C Date: 7 <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> _.. pans 5 of A <br />