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APPLICATION - SITE APPROVAL <br /> 1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • ce FILE NUMBER: SA- <br /> 9� FOR� <br /> Other <br /> -... .. <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> S- <br /> �4 �r� �t t_P►N �� �2�, _ � 'P w� ��,�caZ�b re S��, <br /> Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy e ui ment,etc. : <br /> W LA2 <br /> Describe any on-site.or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> (` o eAA,Vn,,L s,7'5- H 6, �r-,N D S�D \c�,LL testi Ll- <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> O c,i4 cz- .--7414 N -V�4 a S Hn 4.LL. 6�►0 �stti�0 <br /> Describe any displacement of people-that will be caused by the project(e.g. numbers of people,housing units): <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 and correct. <br /> Print Name: Y [-1St( SL� Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />