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APPLICATION -- SITE APPROVAL <br /> w y� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Ll�oa <br /> a��• FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> ZU/41- <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)7 <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g, numbers of people, housing units): <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 t r behalf., and that the foregoing application statements <br /> are trnd correct. <br /> Print Name: Signature: A. date: <br /> r <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: _ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:VFVSVCIPtanning Application FormslSde Approval.(Revised 02-03-10) Page 5 of 9 <br />