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°Pliyt>o APPLICATION — SITE APPROVAL <br /> y <� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r � FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> A10A1E <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment, etc. : <br /> "Al, - <br /> Describe any on-site or off-site sources of light of glare (e.g.parkinglot lighting, or reflective materials used): <br /> /-Or 1,,6A1P1A14 7P QE d L curoFf <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): <br /> A-Z&C <br /> Describe any displacement of people that will be caused by the projed e. . numbers of people, housing units): <br /> /tICAYE <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 /> ❑ 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: /loll �S/MK✓ Signature: Date: /A//7 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />