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ip <br /> APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or Structures): iA <br /> Describe any on-site or off-site sources of noise or vibrafion(e.g.freeway noise,heavy equipment,etc. : <br /> Describe any on-site or offsite sources of light of glare(e.g.parking lot fighting,or reflective materials used): - <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. .numbers of people,housing units): ti <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 /> ❑ 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 rgpa s involved in this <br /> application and have been authorized to file on their behalf., and that t foreg Ipg application statements <br /> are true and correct. <br /> PrintNama: William Feldbrill Signature: Date: 3/6/2017 <br /> Print Name: Alexander Eisner Signature: - Date: 3/6/2017 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Dale: <br /> MDEVSVc,lannino Appucauan Farmmsim Appmat.(Revised 02-03-10) Page 5 of 9 <br />