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APPLICATION - SITE APPROVAL <br /> r> �a <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> -r FILE NUMBER: <br /> to <br /> Aeaorioohah Hams of hintdripn!or dmhauola kalintarost bn-alta. a .camotar[ae o+strvelures`. <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway nolle heavy equipment, etc.): <br /> b <br /> Describe any on-site or off-slla sources of light of glare e. _pawng lot II htln ,or reflective materials used <br /> 5�cu <br /> Describe any on-511e or off-site source of odor(e,q.a rlcultural wastes):. <br /> opf_;: <br /> Dascribo any displacement of people that will be caused by the project(e.g.numbers of eeople.housln units): <br /> i <br /> I <br /> AUTHOR12JI[01 81GNATURE8 <br /> ONLY THE OWNER OF THE PBOPERTS"OR AN AUTHORIZED AGENT MAY PILH Aft 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 OwnerlAgerift project. <br /> I,further,certify under penalty of perjury that I am (check one): <br /> ('x Legal property owner(owner Includes partner,trustee,trustor, or corporate officer)of the properly(s) <br /> involved in this appllcatlon, 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, 6l Slgtratare:. Date: - <br /> Print Name: Signature:._,. Date:^ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date:. <br /> Print Name: Signature: Data: <br /> F.10EVSVCW2nn112APPAlen F0Ms%S11n Appvvel.(nav4cd 026&10) Pages of <br />