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Pa.Utk. APPLICATION — SITE APPROVAL <br /> N r = SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> -..�....- .c J FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> ,NONE <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc. : <br /> ACE TRAIN <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> NONE <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> NONE <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units): <br /> NONE <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ❑X 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., an that the foregoing application statements <br /> are true and <br /> correct. <br /> Print Name: r �l I`/L _Stl� i' < <� Signature: Date: / 772 <br /> / <br /> Print Name: Signature: Date:___-____—_ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date:-----— <br /> Print Name: Signature: Date: <br /> F:\DEVSVQPlanning Application Forrns\Site Approval.(Revised 6-03-04) Page 5 of 9 <br />