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i <br /> APPLICATION -- SITE APPROVAL <br /> f �o•.�.cp <br /> uiiiiSAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT'DEPARTMENT'FILE NUMBER: SA- <br /> ! <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> �i <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise heavy equipment,etc-): <br /> IVIA <br /> i <br /> i <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> At LA <br /> Describe an on-site or off-site source of odor(e,q.agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units): <br /> i <br /> ArA <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 /> f ❑ Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of the property(s) <br /> G involved in this application, or <br /> XrLegal 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 <br /> d correct. <br /> Print Name: 19AI k"� Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name- Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> i <br /> I <br /> F:WEVSVC Flanning Application FonnslSite Approval.(Revised 02-08-10) Page 5 of 9 <br />