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opV!ty <br /> -�r- APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeological interest on-site e. .jor <br /> structures), <br /> L1� <br /> Describe an on-site oroff-site sources of noise or vibration(e.g. freeway heavy ui ment,etc.): <br /> ,zr,�.� c *to F;L a F s,+� <br /> Describe an n-site or off-site sourcesof li ht of lave e. . arkin loive materials used : <br /> Describe an on-site or off-site source of odor e. . a ricultural wastes <br /> C, <br /> Describe an dis lacement of people that will be caused by the projeScUe.q. numbers of People, housing units): <br /> in ✓�( <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 /> 1, further, certify under penalty of perjury that I am (check one): <br /> X 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 forego' p I ation statements <br /> are true and correct. j <br /> Print Name: \ O✓'� l Cw.y,�'t•� , /I <br /> gn tures <br /> Date: <br /> Print Namecai'U_,__�4L <br /> Date: <br /> Print Name: Signature. <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> 'DEMMIolanning Applicalion FonnslSite Approval.(Revised 02-03-10) Page 5 of 9 <br />