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"- `° Other APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �'q..,. .--:�P FILE NUMBER: SA- <br /> Describe <br /> Describe an items of historical or archaeological interest on-site e. . cemeteries or structures): <br /> Describe anV 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 /> I <br /> Describe an on-site or off-site source of odor e. .agricultural wastes): <br /> Describe an dis lacement of p eo le that will be caused b theproject(e.g. numbers of people, housing units): <br /> r <br /> AUTHORIZATION SIGNATURES <br /> [-the <br /> THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> ner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> es from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> r, certify under penalty of perjury that I am (check one): <br /> l property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> lved in this application, or <br /> l agent (attach proof of the owner's consent to the application of the property's involved in this <br /> ication and have been authorized to file on their behalf., and that the foregoing application statements <br /> rue and correct. <br /> : Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: EEE Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSVCWIanning Application FonnslSite Approval.(Revised 02-03-10) Page 5 of 9 <br />