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l°pera APPLICATION - SITE APPROVAL <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \ - :4 FILE NUMBER: SA- <br /> ��Ixo�/ <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e,g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment, etc. : <br /> t�lQ <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting,or reflective materials used): <br /> I`10 I'. <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> U <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> ` AUTHOR[ZZJ4Tl4N SIGH ATO-SES <br /> ..,'DNLY"NE OWNER. OF THE PROPERTY OR'AN AUTHORIZED AGENT MAY r 1LE 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 am (check one): <br /> ❑ Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the propel <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 behIf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Signature: Date: l2 • H•4� <br /> Print Name: Signature: Date: <br /> Print Name: Signature- Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F IDEVSVMPIanning Application ForrnsSSite Approva€.(Revised 05-11-09) Page 5 of 9 <br />