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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeological interest on-site fe.q cemeteries or structures): <br /> NONE pp <br /> 1 <br /> Describe any on-site or off-site sources of noise or vibration(e. .freeway noise.heavv equipment.etc.): <br /> FREEWAY NOISE <br /> r <br /> I i <br /> Describe an on-site or off-site sources of light of glare(e.g.parkinglot lighting.or reflective materials used): <br /> NONE <br /> l � <br /> gDescribe any on-site or off-site source of odor(e.g. agricultural wastes) <br /> u NONE <br /> l <br /> pDescribe any displacement of people that will be caused by the project(e.g. numbers of people housing units): <br /> NONE <br /> I: <br /> i <br /> AUTHORIZATION SIGNATURES <br /> uu 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 Owner/Agent's project. <br /> ii <br /> I, further, certify under penalty of perjury that I am (check one): <br /> 0 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 /> Robert E Heisler Date: -s <br /> Print Name: Signature: <br /> Print Name: Dale A Cose Signature: Date: y G <br /> Print Name: Signature: Date: <br /> IIq Print Name: Signature: Date: <br /> q Print Name: Signature: Date: <br /> oEvsvcPianniw Avp',waen FDr Ss Slte ApptWal.IRevlsea o9-m-091 Page of <br />