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APPLICATION - SITE APPROVAL <br /> 2' r— <br /> / SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> tJ A <br /> g <br /> -s to or off-s to sources of noise orvibrat on e. .freewa noise, hea a ui ment,etc.eva-site or off-site sources of li ht of lare e. . arkin lot li htin , or reflective materials used : <br /> -site or off-site source of odor e. .a ricultural wastes : <br /> 1�s lacement of eo le that will be caused b the ro'ect e. . numbers of eo le,housin 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 /> 14 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: ZAp VAN 4 Z Li vlAJGltw1 Signature: Date: / )Z2- 118 <br /> Print Name: LfluK1f VAN CaRoNWCEiJ Signature: Date: 1 (22 t <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVMPlanning Application Fonns\Site Approval.(Revised 02-03-10) Page 6 of 10 <br />