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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Otter _--- <br /> /Describe an items of historical or archaeological interest on-site e.. .cemeteries or structures): <br /> (W <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 fighting,or reflective materials used); <br /> Describe any-on-site or off-site source of odor(eq.a riwttural wastes): <br /> Describe any displacement of people that Wil be caused by the pmiect e. .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 /> 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: AA-W)wn EA&J&f�4 Signafu . Date: Zv-e <br /> Print Name: Signature: Date: <br /> Print Name: Sig ire, Date:. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date:__ <br /> F:\DEVEIMPlanning Application Forms\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />