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! ApUl�y <br />APPLICATION - SITE APPROVAL <br />M r <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NUMBER: SA - <br />y items of historical or archaeological interest on-site (E <br />ite or off-site sources of noise or vibeat <br />Describe any on-site or off-site sources oflight of glare (e.g. parki <br />Describe any on-site or off-site source of odor (e agricultural wa <br />r <br />Describe any dis lacement of people that will be caused by the ou <br />or structures <br />ioise <br />lot lighting, or <br />numbers of <br />AUTHORIZATION SIGNATURES <br />materials <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 Owner/Agent's project - <br />I, further, certify under penalty of perjury that I am (check one): <br />C] 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:��j Signature: <br />Date: <br />Print Name: <br />_. Signature: - Date. <br />Print Name: <br />_ Signature: <br />--- _ - Date: <br />Print Name: Signature: Date: <br />Print Narno:Signature: <br />Date: <br />F:0EVSVMP1anning Application Forrns%Site Approval. (Revised 1-3-03) Page 5 of 9 <br />