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APPLICATION SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> NOR, <br /> Describe any items of historical or archaeologo I interest on-site(e.g.cemeteries or structures): <br /> Existixg ivdustrial site - none kRt(3wx <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> Existixg industrial site - xinxe Imewx <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot li2hting,or reflective materials used): <br /> Existirg industrial site - xtoxe known <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Existixg industrial site used primarily for cold storage - gioxe kn6w)a <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units): <br /> Name <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> 1, further, certify under penalty of perjury that I am (check one): <br /> FX-� Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> El- 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. Z I <br /> Print Name: 6G 61 2. Signature: r Date: ///-7 LO-L_ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date, <br /> Print Name: Signature: Date: <br /> Print Name.- Signature: Date: <br /> P:NDEVSVOPlanning Application FormskSite Approval (Revised 1-3-03) Page 5 of 9 <br />