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^.c class <br /> 16. <br /> APPLICATION - SITE APPROVAL <br /> ".�� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ° " . FILE NUMBER: SA- <br /> Other <br /> Foescribe <br /> an items of historical or.archaeolo 'cal interest on-site e. .cemeteries or structures): ^ "' e <br /> an on-site or off-site sources of noise or vibration e. .freewaynoise heavyequipment,etc. : v-� c, `� e <br /> Me <br /> -site or off-site sources of light of tare e. parkinglot lighting,or reflective materials used)* '�` <br /> -site or off-site source of odor e. .a ricult...m wastes : h r "-' <br /> lacement of eo le that will be caused b the ro'ect e. . numbers of people,housingunits): r "' <br /> AUTHORIZATION SIGNATURES <br /> OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION.gent 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 /> B 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 applica 'on of the property's involved in this <br /> application and have been authorized to file on their behalf. rid that the foregoing application statements <br /> are true`and correct. <br /> Print Name: y e' ^ j t e '�''�ti Signature: C� Date: � Z 12 <br /> Print Name: e n 5 e J t C'�' a �� <br /> V Signature: Dater "tom <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FoevsvaP1anmrg Apprce ion Foans\Sde Approval.(Revbee d oz-os-io) Page 5 of 9 <br />