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v ✓ <br /> APPLICATION - SITE APPROVAL <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.g.cemeteries or structures): <br /> l� <br /> Describe any ort-site or off-site sources of noise or vibration e. .freeway noise, heavy a ui ment, etc.): <br /> ONE <br /> Describe any on-site or off-site sources of light of glare e.q. parkinglot lighting,or reflective materials used): <br /> JCS Ll <br /> / 67 <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): <br /> b E <br /> Describe any displacement of people that will be caused by the project e. . numbers of people, housing units): <br /> b � <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 /> ❑ 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: -���f R rsA-/!--s�,4- Signature: Dater <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> PoEvsviaplanninp Application ForrnMSita Approval.(Revised 13-03) Page 5 of 9 <br />