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'o Pq co <br /> APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER. SA- <br /> �tFpR <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> 11 <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> A., 1_�A-&JEL ll,, <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> Describe an on-site or off-site source of odor(e.g. agricultural wastes): <br /> A <br /> Describe an displacement of people that will be-caused by the project(e.g. numbers of people,housing units): <br /> t <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 u <br /> employees from any claim; action or proceeding againstlhe County arising from the Owner/Agent's project. <br /> i, further, certify under penalty of perjury that I am (check one): <br /> < 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. i r <br /> Print Name: <br /> '�lf�lL'i Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> LPrintame: Signature: Date: <br /> ame: <br /> Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 6 of 10 <br />