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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> 9LfFpR'� <br /> I <br /> Other <br /> Describe any items of historical or archaeological 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.eta): <br /> U <br /> Describe any on-site or off-site sources of light of qlare e. .parking lot lighting.or naflective materials used): <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> � D <br /> Describe any displacement of people that vAil be caused by the project(eg.numbers of peoRle.housing units: <br /> u6 <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 OwnerlAgent's project. <br /> 1,further, certify under penalty of perjury that I am (cheat 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!0,Vs ,Ly 0 � �p�t�vt�A _ Signature: Date: <br /> Print Name: n AN�EEC S b K tti— Signature: t Date: rA . <br /> Print Name: Signature: <br /> Print Name, Signature: Date: <br /> Print Name: Signature: Date: <br /> F:%0EVSV0\Pl ".q Application Fd s\Sile Approral.(Rs ed 02-03-10) Page 5 of 9 <br />