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APPLICATION - SITE APPROVAL <br /> " < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> is <br /> �rFoa? <br /> FILE NUMBER: SA- <br /> Other <br /> Ron-siteor <br /> istorical or archaeological interest on-site(e.g. cemeteries or structures): <br /> off-site sources of noise or vibration (e.g. freewaynoise, heavyequipment, etc. : <br /> off-site//sources of li ht of glare(e.g. arkin lot lighting,or reflective materials used : <br /> I%' C G r /Yi 4,. <br /> Describe an on-site or off-site source of odor e. . agricultural wastes): <br /> /O 1 <br /> Describe an dis lacement of people that will be caused by the pLoject e. . numbers of eeople, housing units): <br /> i <br /> AUTHORIZATION SIGNATURES <br /> Femployees <br /> OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> /Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers an <br /> om any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> ify under penalty of perjury that I am (check one): <br /> perty owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> 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: Acca 16rl-'V Ac- v o Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVC1Pianning Application FonnsGte Approval.(Revised 02-03-10) Page 6 of 10 <br />