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APPLICATION "-SITE AP-PROVA.._ <br /> µ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe an items of historical or archaeological interest on-site e. .cemeteries or structures <br /> 0 <br /> Describe an onsite or of-site sources of noise or vibration(e.g.free M noise,heavyui ment,etc.): <br /> p -� iw Ci /' ren n d n 5 hof <br /> Describe an on-site or off-site sources of h t of-glare e. . aNn lot lighting,or reflective materials used): E <br /> i <br /> FE <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 pTject e. .numbers of people,housing units : <br /> v �= <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 /> xQ 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: O0,t Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RM)EV5=111anning Appiicaton FormsMe Approval.(Revised W1"S) Page 5 of 9 <br />