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APPLICATION - SITE APPROVAL <br /> Q: <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N: •<J <br /> j FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.,q.cemeteries or structures): None <br /> Wonsite off-site sources of noise or vibration e. .freewa noise, heav a ui ment, etc. : None <br /> r off-site sources of li ht of lare e. arkin lot li htin , or reflective materials used : Existin street li htin . <br /> r off-site source of odor e. . agricultural wastes): <br /> None <br /> Describe an dis lacement of people that will be caused by the project(e.g. numbers of people,housin units): None <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> rFl, 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 /> 1, 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. <br /> Print Name: D Signature: _�`�� �' jr� Date: / 6 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> _. n......a ..Fn <br />