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O PO_U 1/y <br /> X <br /> ° APPLICATION - SITE APPROVAL <br /> 2: G <br /> N' <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • " � . FILE NUMBER: SA- <br /> ' C/FORS_. <br /> Other <br /> Mon-siste0oroff-silte <br /> or archaeological interest on-site (e.Q. cemeteries or structures : <br /> ources of noise or vibration(e.g.freeway noise, heayy equipment, etc. : <br /> Describe an on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> Describe an on-site or off-site source of odor(e.g. a ricultural wastes <br /> Ox-/65-- <br /> Describe an displacement of people that will be caused b the project(e.g. numbers of people, housingunits)7 (� r <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, officer <br /> employees from any claim, action or proceeding against the Owner/Agent's project. sand <br /> I, further, certify under penalty of perjury that I am (check one): <br /> 9 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 i <br /> application and have been authorized to file on their behalf., and that the foregoing application t(tements <br /> are true and correct. <br /> Print Nam v T v�E <br /> Signatu <br /> Print Name: Date: Z.;--C) r <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Date: <br /> \DEVSVCIPIanning Application Forms\Site Approval.(Revised 1-3-03) Page 5 of 9 <br />