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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe anit ms of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> _y <br /> Describe any on-site or off-site Sources of noise or vibration freeway noise,heavy equipment,etc.): <br /> Describe an on-site or off-site sources of light of glare(e.g.parking lot fighting,or reflective materials used: <br /> De cribe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any displacement of people that will.be.caused by the project(e.g.numbers of people,housing units):- <br /> gol-AML <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENTMAYAN-APPLICATION. <br /> 1, 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 /> EJ 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 Signature: ` a�4­11 ate: <br /> are <br /> ON <br /> FIA <br /> TI <br /> officers and <br /> em, project <br /> true <br /> Pr'nt Name <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 'r' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> U 7" <br /> F:1DEVSvC1Piannmg Application FormslSite Approval.(Revised 02-03-10) Page 5 of 9 <br />