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APPLICATION - SITE APPROVAL <br /> Ye SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): <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 oft-site sources of light of glare e. . parking lot lighting, or reflective materials used): <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 /> El Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ā‘ Legal agent (attach proof of the owners 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: Ne,,HR/)7 Ai A D k-F h tV Signature: A a<uu tKA,,1' G<.6: Date: <br /> Print Name: "rte 6/2 V C:AW S kHAI\f Signature: PAI) ilA6u Sā€¢ AAAec Date:_Z.:&ā€”2ol q <br /> Pdnt Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.IDEVSVOPlannmp Appllce Foans%Site Approval.(Revised 02-03-10) Page 5 of 9 <br />