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APPLICATION - SITE APPROVAL <br /> SAN JOAC]UIN COUNTY COMM17- <br /> UNITY DEVELOPMENT DEPARTMENT <br /> 9, l <br /> P~ FILE NUMBER. SA- <br /> Other <br /> Describe:,any Mems of historical or archaeol2gical interest on-situ je.9,cellletartes or strUClUreS1: ._. <br /> kDescnbe,an on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy ettuipMont etc. : <br /> Describe any on-site or off-site sources of light pt glare e. arkin lat fi htm or retieetlue Maier at <br /> used <br /> Describe any onsite or oh-site source of odor(e.g. agricultural wastes): <br /> Describe any displacement of pepple that wilt be caused by the project e. ,numbers of le,hpustn Umfs'- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILlinthis CATION. <br /> 1, the ©wnerfAgent agree, to defend, indemnify, and hold harmless the County andfficers and <br /> emplo�iees 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 /> El Legal property owner (owner includes partner, trustee, trustor, or corporate officeerty(s) <br /> involved in this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the propertythisapplication and have been authorized to file on their behalf., and that the foregoinstatements <br /> ar I¢ true and correct. <br /> f r <br /> Print NaMB: 6 _/ �! :) f".GL LSignature. f...�..._ Date:--/, "Q„�_-.... <br /> Print N Ia#ne: Signature: Date:.._____ <br /> Print Naine: Signature: Date: <br /> Print N”: Signature: Date: _....,.......__..__�-..-_ <br /> Print Name: .-- _. Signature: - Date <br /> F:DE V SVC1Prann,g Appa Zt ri rw�<s W Approval.tnev,sen 6 03 041 Page 5 of 9 <br />