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Pa�IN APPLICATION ® SITE APPROVAL <br /> ,o. .C, <br /> SAN .iOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> NC*J E—� <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise,heavy equipment, etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting, or reflective materials used): <br /> 1 <br /> L <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> r.7c;be an displacement of people that will be caused b the project(e.g. numbers of people,housingunits): <br /> e4 <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 /> _ . <br /> Print Name: 9 �\1 Lai Signature: �_ Date: 05 -W(7Zi <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F•\DEVSVC\Plannino Anolication Forms\SHe ADnroval.(Revised 02-03-10) Pace 5 of 9 <br />