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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. .cemeteries or structures : <br /> None <br /> Describe anv on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc.3: <br /> None <br /> Describe any on-site or off-site sources of light of lare e. .parKing lot lighting,or reflective materials used): <br /> None <br /> Describe any onsite or off-site source of odor e. .agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project e. .numbers of people,housir units): <br /> No effect <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 owners consent to the application of the property's involved in this <br /> application and have been authorized to file on their be aIf., and t at the foregoing application statements <br /> are true and correct. <br /> Prim Name: Rona Royan Signature: - ,,,,,,,, ate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSMRIanning Appiicadcn Fonns%te Approval.(Revised 02-0310) Page 5 of 9 <br />