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a (y. <br /> S: -F�to <br /> - �, �.�, APPLICATION - SITE APPROVAL <br /> <1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> n . ky. FILE NUMBER: SA- <br /> Other <br /> Describe any i ems of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe any o -site or off-site sources of noise or vibration e. .freeway noise,heavy equipment.eta: <br /> Describe an n-site or off-site sources of light of glare e.g,parkin lot lihfin ,or reflective materials used): <br /> d e, <br /> Describe anin-site or off-site source of odor e. .agricultural wastes): <br /> Describe an dis laoement of people that will be caused by the project(eg.numbers of peorile.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 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 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 /> X <br /> Print Name; !% L�/�',¢ ���l�l-/¢( Signature: Date: ' ,�7a/`/' <br /> Print Name:•. -1—eA as 'v+"-`9fr � Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Namw Signature: Date: <br /> Print Name: Signature; Date: <br /> e10EVSMPlanoing Apo canon Fam5A5ne Approval,(Revised 01.03-10) Page 6 of 10 <br />