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t�• . APPLICATION - SSITE APPROVAL <br /> O.••' C a <br /> 2• .y <br /> N '< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c <br /> FILE NUMBER: SA-P • J <br /> Other <br /> Describe any 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.g.freeway noise, heavy equipment, etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> n Q h <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): IQUAl LU ern --h) <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> h <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, th Owner, gent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employ om any claim, action or proceeding against 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: Y Signature: Dated <br /> Print Name: UI G S e 'r Signature: 6Z - Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.\DEVSVC\Planning Application Forms\Site Approval.(Revised 1-3-03) Panp 5 of 9 <br />