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a64 APPLICATION - SITE APPROVAL <br /> o- SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> /IMt <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment, etc. : <br /> �snc <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> n®nt <br /> Describe an on-site or off-site source of odor e. .agricultural wastes): <br /> 44A1 <br /> Describe any itis lacement of people that will be caused by the project(e.g. numbers of people,housing units): <br /> 4401K <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, indefnnify,'and hold harmless the County and its agents, officers and <br /> employees frorp any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> I, further, certify under penalty,of•perjury that;l am (check one): <br /> } Legal property owner(owner iridudes 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: Lk4d Signature: Date: <br /> Print Name: EWE Signatyre: Date: <br /> Print Name: Signature: Date: <br /> Print Name: •- Signature: Date:. <br /> Print Name: ' - 'Signature: - Date: <br /> POEVSVQPlannirg Application Fo"sZite Appmv l-(Revised 02-03-10) Page 5 of 9 <br />