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.�U'rNL APPLICATION - SITE APPROVAL <br /> N; p< <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : r c ^G <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): ^ C7 �- <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe an displacement of people that will be caused by the project e. .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 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: V e rrt JV. l e f-w a Signature: Date: <br /> Print Nam `e: --� �'•�I Sc M. V to✓a Signature: Date: S 1 ti 05 <br /> Print Name: Signatur . Date: <br /> Print Name: Si ature: Date: <br /> Print Name: Signature: Date: <br /> F IDEVSM[olanning Application FormsVSite Approval.(Revised 1-3-03) Page 5 of 9 <br />