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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �4L7VoR��P <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> None <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> None <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> .None <br /> Describe any displacement of people that will be caused by the ro'ect(e.g. numbers of people, housing units): <br /> None, <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 /> 0 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: B'&-tIM �1 LtotiwQ Signature: Dates I 1 _ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date:-- <br /> Print <br /> ate: _Print Name: Signature: _ Date: <br /> Print Name: Signature: _ Date:_ _ <br /> F:\DEVSVC\Planning Application Forms\Site Approval.(Revised 07.-03-10) Page 5 of 9 <br />