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".•°U'''"ss APPLICATION - SITE APPROVAL - <br /> N, � SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> old I > <br /> � P FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freewaynoise,hea equipment,etc. : L <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 any displacement of people that will be caused by the project e. .numbers of people, housing units <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 trueandcorrect. <br /> Print Name: 156.rr G ,l ,f&11111W Signature: Date: <br /> A' 5� <br /> Print Name: l�i1�1 /' r rte/ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forrns\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />