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APPLICATION — SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Dmeriao any Items of hlatodcal or - Tat '016II11d e. .mmelerlea orsimclores: <br /> Deescrib4�e.'�an on�slle or off-size sources.of noise or vibration(e.g.freewa nolse heov equipment, etc. : <br /> ri� <br /> �tn� <br /> Describe any on-site a off-silo sources of light of ritare e. .parkinp lot irlhtIrg,ar reflective materials usod : <br /> Describe any on-site or of(-site source of odor(e.g.agricultural wastes <br /> 4h.y <br /> Describe any dts lacemenl of people that will be caused by the project e. .numbers of people,housln units <br /> I <br /> wW <br /> ONLY THE OWNER OF THE Pte0#6R'IT'OR AN.ALITHORIZED 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 em (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 bean authorized to file on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> -Print Name7TC110 rC1nafil,1 Dala- - <br /> Print Name: Signature: Date:,, <br /> 'Print Name: Signature! Date: <br /> Print Name: Signature: Date: <br /> .Print Name: Signature: Dote; <br /> FJDEVSVCVnannlsp APP1� FomslSli-App.o..L(nedsed02-03-10) Page 5 of 9 <br />