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APPLICATION - SITE APPROVAL <br /> ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ra• .e <br /> FILE NUMBER: SA- <br /> FO <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 /> Traffic on East Fremont Street. Highway 99 is less than one mile from the site. <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> Building mounted security lights. <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastesl: <br /> N/A <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people.housing units): <br /> N/A <br />' AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> l 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 /> ❑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., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: <br /> D/w d Signature: t! Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSMPlanning ApplicaGan FarmslSite Approval.(Revised 02-03-10) Page 5 of 9 <br /> 4 <br />