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APPLICATION - SITE APPROVAL <br /> c 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): W O(J <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy ecluipment,etc. : <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting, or reflective materials used): D <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 proded(e.g. numbers of people,housin units): fJDtJt; <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 /> F j 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 Name: __, ._ ••�• - _ Signature: )a Date: <br /> Print Name: _ Signature: - _ Date: <br /> Print Name: Signature: Date: -r�vYa <br /> Print Name: SVE Sr""—• -- Signature: � '� Date:,J�N, I�419 <br /> Print Name: Signature: Dale: <br /> F:\DEVSVC\Planning Apphi bon Fonns\Site Approval.(Revised 09-10-08) Page 5 of 9 <br />