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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Q: <br /> N < <br /> .. FILE NUMBER: SA- <br /> 9ticoR`' <br /> aOther <br /> ces of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> ite or off-site sources of noise or vibration (e.g. freewaynoir heavyequipment,etc. : <br /> ite or off-site sources of li ht of lare e. arkin lot li htin ,or reflective materials used : <br /> ite or off-site source of odor e. . a ricultural wastes): <br /> Describe any displacement of peo2le 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 /> 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 /> Print Name: S k If N c,h A-1 N G fit. Signator �'- `'� e: 2 19 I L <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F\DEVSVOPlanning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br /> Id <br /> t <br />