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P U(N APPLICATION - SITE APPROVAL <br /> 0.... . <br /> �f OG <br /> 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): Q /� <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : 0 Z <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting, or reflective materials used): () <br /> Describe 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 /> 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 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: 1w� Iyw ugRS- Signature: ��. _ �1ne Date: —/9—('G <br /> Print Name: Signature: 1 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: _ <br /> A—k—r,,., n,nrnvai (P—i—H F_ns_na) Pane 5 of P <br />