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APPLICATION - SITE APPROVAL <br /> L= q—cro .G <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c FILE NUMBER: SA- <br /> 9 %FORS <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> Ov.Q� <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise heavy a ui me , etc. : <br /> h! O <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or r ective materials used): <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): <br /> o <br /> Describe any displacement of people that will be caused by th ro'ect e. . numbers of people, housing units): <br /> AUTHrVAUZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROP RTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Ag/eedee, to defe , indemnify, and hold harmless the County and its agents, officers and <br /> employees fromm, action r proceeding against the County arising from the Owner/Agent's project. <br /> I, further, certifyenal of perjury that I am (check one): <br /> ❑ Legal proper wrier includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in ttion, orLegalagentroof of the owner's consentto the application of the property's involved in this <br /> application abeen authorized to file on their behalf., and that the foregoing application statements <br /> are true and <br /> Print Name: Signature: Date: . <br /> Print Name: Signature: Date: <br /> Print Name Signature: Date: <br /> Print Na e: Signature: Date: <br /> Print ame. Signature: Date: <br /> F:IDEVSMPlanning Application Fonns\.Site Approval.(Revised 02-03-10) Page 5 of 9 <br />