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e « , <br /> APPLICATION SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: 'SA- <br /> Other <br /> Describe,-.any items of historical or archaeolo 'teal interest ors-site 1!e.q.cemeteries or structures): <br /> None known. <br /> Describe any on-site.or off-site sources of;noise.or vibration.e.a.freeway noise,heavy,eq ui ment,etc:): <br /> Pile driving will occur during construction.Trains will operate on the rail line. <br /> Describe�any on=site or.off-site.sourcesof.light of glare(e.g.parklngwlbtlighting,or reflective materials used): <br /> None. <br /> Describe any on-site or--off-site::source of odor e: .-a ricultural wastes): <br /> None. <br /> Describe:an dis lacement of eo ie,that!will be caused b `the er6ject(e;g.numbers of people,housin units : <br /> None. <br /> AUTHORIZATION SIG'NATURES <br /> ONLY THE. OWNER;OE'THE.PROPERTY QR AN:AUTHORIZED AGENT MAYFIL E AN APPLICATION. <br /> I, the Owner/A9 agree, to:defend, indemnify, :and hold :harmless the County and'its agents, officers and <br /> employees:from any claim, action or proceeding.agaihst_the County arising-from the Owner/Agent'&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 /> .❑ Legal;agerit,(atkach proof ofAhe owner's consent to the application of the property's-involved in this <br /> application and have.been authorized to file on thein behalf., and that the foregoing application statements <br /> are-true and correct. <br /> Print Name: __c>WAk&j, �l"r Signature: Date: 'Z <br /> Print Name: _ Signature:. Data: <br /> Print Naive: _ ;Signature: Date: <br /> Print Name: . _ Signature: Date: <br /> Print Name: ! Signature: Date: <br /> FADEvsvmPianning Applicat€on FormMSIte'Approvah(Revised 02-03-90) Page-5 of 9 <br /> I <br />