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APPLICATION QSITE APPROVAL <br /> ,SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> � P I FILE NUMBER: SA- <br /> i. <br /> Other <br /> Describe iply 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. .freeway noise, heavy equipment, etc. : <br /> I <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> ,i <br /> f <br /> Describe any on-site or off-site source of hodor Je.g.agricultural wastes): <br /> l . <br /> v F' �r f rvrn-eS <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people,housing units): <br /> F <br /> I' <br /> AUTHORIZATION SIGNATURES <br /> 'k <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> ,I. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and ! <br /> employees from any claim, actions or proceeding against the Owner/Agent's project. <br /> ,p <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: j'Uttd cD i'If l� Signature: Date: <br /> Print Name: Signature: Date, <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> F:IDEVSVC%PIanning Application Forms%site Approvai.(Revised 13-03) Page 5 of 9 <br /> I <br />