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, <br /> . f <br /> APPLICATION - S FE 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.g.cemeteries or structures : <br /> Describe any on-site or off-site sources of noise or vibration(e.q.freeway noise,heavy equipment,etc. : <br /> 61s e <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> Ale 4(f <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 promect e. .numbers of eeople,housing units): <br /> OSI <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that l 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 />+a <br /> Print Name:- Signat e <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> I Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> FMEVSVW1anning Application FormslSite Approval.(Revised&03-04) Page 5 of 9 <br /> a <br /> f <br />