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APPLICATION - SITE APPROVAL z: SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: SA- Other Describe any items of historical or archaeological interest on-site e. . cemeteries or structures): 1K Des ibe any on-site or off-site sources of noise or vibration e. .freeway noise, heavy equipment, etc. : tiv Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): Describe any on-site or off-site source of odor(e.g. agricultural wastes): Des ribe anyisplacement of eo le that will be caused by the project e. . numbers of people, housing units): AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. I, further, certify under penalty of perjury that I am (check one): ❑ Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application, or ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this applicatio and have been authorized to file on their b alf., and that the foregoing application statements are true an correct. Print Name: Signature: L Date: A�" Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: