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r <br /> i - <br /> APPLICATION -- SITE APPROVAL <br /> { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c•.: -..�P FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical orarch icaI interest on-site(e.g.cemeteries or structures): <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.g.park[aqlot li htin ,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any dis lacement of people that will be caused by the project(e.g. numbers of people,housing units): AIOAlt�-- <br /> r <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 protect. <br /> I, 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 plication of the property's involved in this <br /> application and have been authorized to file eir be f., and that the foregoing application statements <br /> are true and correct. t <br /> Print Name: ►Y\ '' �CL��tw igna ate: ], tX.1�y 70tLX <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVMPIanning Applicafto Forms\Site Approval.(Revised 02-03-90) Page 5 of 9 <br />