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APPLICATION - SITE APPROVAL <br /> 2 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �'• FILE NUMBER: SA- <br /> 9(i F iJRa` <br /> Describe an items of historical or archaeological interest on-site e. . cemeteries or structures): { <br /> Describe an on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment, etc.): <br /> Describe an on-site or off-site sources of li ht of tare e. . arkin lot lighting, or reflective materials used : <br /> Describe an on-site or off-site source of odor e. .agricultural wastes): <br /> Describe an displacement of people that will be caused b the project e. . numbers of people, housingunitsl: <br /> AUTH0MZAT.1 N SIGNATURES <br /> rinvolved <br /> HE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION.' <br /> er/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> certify under penalty of perjury that I am (check one): <br /> property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> d in this application, or <br /> agent (attach proof of the owner's consent to the application of the property's involved in this <br /> tion and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Lzktf M , Signature: <br /> Print Name: il ce, Signature: <br /> Date: S�j� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FIDEVSVMPlanning Application FomsGite Approval.(Revised 02-03-10) Page 5 of 9 <br />