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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •• FILE NUMBER: SA- <br /> IP06 ------- <br /> Other <br /> Describe any items of historical or archaeological Interest on-site e. .cemeteries or structures): <br /> G <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc. : <br /> /VOit/�--- <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot Righting,or reflective materiats used): <br /> N._ <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> U ,-- <br /> Describe <br /> Describe an dis lacement of people that will be caused by the project e. .numbers of people,houshp units): <br /> IVIV N F <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 /> 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 propertys 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: r/J���//�'" Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FIDEVSVCW1annirp Appfi etbn Fd 91 a Apprwel.(RmIsW 02-0310) Page 5 of 9 <br />