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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> h* <br /> Describe any items gf historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> in <br /> Describe any on-site,or off-site sources of noise or vibration(e.g.freeway noise,heavy a uipme%etc.): <br /> V acej-\- -k-C, e a,--,\e c--k- L <br /> & k4c! v st3.t. ,eu t4ratse t!6066-n 11� <br /> Describe art v on-side or off-site soues of light of glare(e.g.Parking lot lighting,or reflective materials used): <br /> rd In, -I-"— V (Lop&ci- �I � W,l1 b� A :6 <br /> V\AomaC" <br /> Describe <br /> ?C6 <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any displacement of People that will be caused by the project(e.g.numbersof people,housing units): <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF.THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> 1, further, certify under penalty of perjury that I am (check one): <br /> F1 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 correcL <br /> 42 <br /> Print Name:C-1 0-,(� F)Q ��- Signature( Date: <br /> Print Name: Signature: Date: <br /> Print Name: — Signature: Date: <br /> Print Name: — Signature: Date: <br /> Print Name: Signature: Date: <br /> F.,\DEVSVCPlanrfing Application ForrnslSlte Approval.(Revised 02-03-10) Page 6 of 10 <br />