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APPLICATION — SITE APPROVAL <br /> a•� a� <br /> zz <br /> o- SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other n <br /> Describe an items of historical or archaeological interest on-site(e.g.cemeteries or structures): IV U ac, <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise, heayy equipment, etc. : H I hw q� <br /> Describe any on-site or off-site sources of light of plare(e.g. parkinglot lighting,or reflective materials used <br /> oSin vt i►I k iIILLmina�rdb4-Li h-in Ci 'o-ai des i ne <br /> r illu.rninahn it o d Vil 0CtuS2, "Ll <br /> Iare <br /> Describe any on-site or off-site source of odor e. .a dcultural wastes): inff)l <br /> Describe an <br /> displace <br /> ment of people that will be caused by the pro6ect(e.g. numbers of people, 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./n�^ /� <br /> Print Name: TeSS I LWA I I I /kc�n n5 Signature: 0[JI CGL Mki n.S Date: J I-S-O <br /> Print Name: �-IFOTI-WbWR ADIENT) Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:OEVSVQPlanning Application FOMMSlte Approval.(Revised 05-11-09) Page 5 of 9 <br />