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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> CfFO .N <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> N <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise,heavy equipment,etc. : <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor e. .a ricultural wastes): <br /> n � <br /> Describean displacement of people that will be caused by the project e. . numbers of people, housing units): <br /> Iv1 � <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 County arising from the Owner/Agent's project. <br /> I, 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 <br /> ^rand correct. <br /> Pdnt Name: F�1ej p 3, L1GI Cl Signature: l�`�/'W lJ Date:1Z t—I <br /> Lu <br /> Print Name: n,L F-04!l4eZ Signature: pc t' w Date: 5 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVOPlanning ApplimUon FonnO to Approval.(Revised 02-03-10) Page 5 of 9 <br />