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` f APPLICATION ;IT <br /> E APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> FILE NUMBER: SA- <br /> Other <br /> EDescHbeems of historical or archaeokMical interest on-site e. .cemeteries or structuresl: <br /> Mew <br /> I Describe any-on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc.). <br /> rn r�zH61se <br /> Describe any on-site or off-site sources of light of glare e. . ricin lot li titin ,or reflective materials u <br /> Describe any on-site or off-site source of odor e. .a culturaf wastes): <br /> i` Describe any dis cement of p2ople that will be ca serf by the pEplect e. .numbers of Mole,housing units: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> E <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 /> 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 /> ALegal 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 Named Signa e• Date:� �3-0 6 <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date <br /> FADMVCUKarvang A 0icadw"FOMWSM Approval.tRevfsW 643-04f Page 5 of 9 <br />