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P4YIb APPLICATION - SITE APPROVAL <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> w. < <br /> 4 P FILE NUMBER: SA- <br /> (/PORN <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> N4 NE; <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise,heavy equipment, etc. : <br /> ?�JJPJE <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting,or reflective materials used): <br /> JIJ <br /> 5t 4o raitt4:iNc— L-i '..j f, i`-i ^Fb o ri f- tz :7 '- A I L <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> ,,joAA <br /> Describe any displacement of people that will be caused by the project(e,g. numbers of people,housing units): <br /> N ONE <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 /> TL41 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 \ �w,'�� Signature: \ l Date: Zb 2 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:OEVSVOPlanning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />