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APPLICATION — SITE APPROVAL <br /> Op,........ C <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> 9LjF0 <br /> Rt, <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> klo,OL <br /> )escribe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> S- <br /> Describe any on-site or off-site sources of fight of glare(e.g. parkinglot lighting, or reflective materials used): <br /> 74;t 16 L i <br /> )escribe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> illo 6 1 E A.v <br /> )escribe any displacement of people that will be caused by the project(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 /> 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 /> Llegal 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 truce and correct. `' <br /> rint NamV 4F�,-Y—J y(,�i�� Jrtr , /signature: 2 j +�,-� 1 2- �J� <br /> `1 Date: 7•� �� <br /> Z-- <br /> rint Name: Signature: Date: <br /> rint Name: Signature: Date: <br /> rint Name: Signature: Date: <br /> rint Name: Signature: Date: <br /> )EVSVC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />