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t <br /> pUl <br /> APPLICATION - SITE APPROVAL <br /> z- . <br /> t° SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> "4L/F p42T <br /> Other <br /> Describe an items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> JJ v <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heayy equipment.etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot fighting,or reflective materials used): <br /> OWE— <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 /> A ?#�ORIZATIONSIGNATURE�__ `.,n ',fi. <br /> ONLY THE OWNER OF Tf E PRQPERT'y OR AN AUTHORIZED TfV134Y <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 /> 34 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: if. _14 l'�Signature: <br /> Y 1ate: - ,Z— <br /> Print Name: Signature: <br /> Jr <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> F`IDEVSVC\Pfanning Application Forms\Site Approval.(Revised o2-m-1o) Page 5 of 9 <br />