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APPLICATION_ - SITE APPROVAL <br /> •�-cow . <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- ^ <br /> 9�%FORS <br /> Other <br /> Describe any items of•historical or archaeological interest on-site e. .cemeteries or structures <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy ui ment,etc.): <br /> Describe any on-site or off-site sources of light of glare(e.g.parldng lot-lighting,or reflective materials used): <br /> N !}- <br /> Describeany on-site or off-site source of odor(e.g.agricultural wastes): <br /> N11 A- <br /> Describe any displacement of people that will be caused by the project e. .numbers of people,housing units): <br /> N A <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILEAN 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 /> 1,,further, certify under penalty of perjury that I am (check one): <br /> EdfLegat property owner (owner includes partner, trustee, trustor, or corporate officer) of the properly(s) <br /> involved injthis application, or <br /> ❑ Legaiage4(attach proof-of the owner's consent to the application offihe propertys involved in this <br /> applicatioiaiand have been-authorized-to fite-on ttteir behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Signature: Date: QJ /Is- <br /> Print <br /> S <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> =;1DEVSVCW1anning Application FonnsZfte Approval.(Revised 0203-10) Page 5 of 9 <br />