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APPLICATION --SITE APPROVAL <br /> �. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `p FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise, heavy equipment, etc. : <br /> 2 <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.g.agricultural wastes): <br /> Describe any displacement of people that will be caused by the project e. . numbers of people, housing units): <br /> P.i <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> k <br /> l property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> ved in this application, or <br /> l agent (attach proof of the owner's consent to the application of the property's involved in this <br /> cation and have been authorized to file on their behalf., and that the foregoing application statements <br /> rue anr/d /correct.: i1"-YVrA eem Signature: �' P �� Date: 0'1—�8-,9: 0 ! Xei M Signature: �aJA� Asm� Date:: /lA D Signature; � Date:: Z"mx4 01-ETA- -iEM Signatures._ � J�r�� Date: <br /> Print Name: Signature: Date: <br /> Fw1FVswnplannina Aoolicabon Fo"s\Sile Approval(Revised 09-10-08) Page 5 of 9 <br />