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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 />Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy equipment, etc. : <br />-)J ,` , <br />Describe any on-site or off-site sources of light of glare e.. parking lot lighting, or reflective materials used)i - <br />Describe any on-site or off-site source of odor e.. agricultural wastes): 1v-0— <br />Describe an dis lacement of people that will be caused by the project e.. numbers of people, housing units <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 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: 6di11f&„o Vk+ Klovvc., Signature ate — �f <br />Print Name:'�71�.L.r. F-lwwti, Signature:- ` S " ?e^rte Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />F:IDEVSMPlanning Application Forms\Site Approval. (Revised 02-03-10) Page 5 of 9 <br />