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APPLICATION <br /> SITE APPROVAL <br /> /: 2\ <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ; <br /> FILE NUMBER: SA- <br /> Other <br /> FDeb <br /> n items of historical or archaeological interest on-site e. . cemeteries or structures): N/A <br /> on-site or off-site sources of noise or vibration(e.g.freewaynoise, heavyequipment,etc. : N/A <br /> Msi' <br /> off-site sources of li ht of 'are e. . parkinglot fighting,or reflective materials used): N/A <br /> off-site source of odor e. . a I ultural wastes : N/A <br /> ent of eo le that will be caused b the pnoject(e.g. numbers of people, housing units): N/A <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 /> x❑Legal agent(attach proof of the owners 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). See Attached Stipulation for Entry of Judgment and Final Order of Condemnation <br /> (pg. 6 Paragraph d — re New Monument Sign and the icense & M tenance Agrmt. Exhibit E thereto). <br /> Print Name: Douglas J. Rishwain V.P.&Sec Signature: ? Date:11/3/11 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RMEMC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />