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APPLICATION - SITE APPROVAL <br /> / SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> P FILE NO: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc.): <br /> None <br /> Describe any on-site or off-site sources of light of glare (e.g. parking lot lighting,or reflective materials used): <br /> None <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> See attached exhibit No.3 <br /> Describe any displacement of people that will be caused by the project (e.g. numbers of people,housing units): <br /> No people will be displaced. <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 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, grantor, 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 <br /> statements are true and correct. <br /> Print Name: Signature: Date: _ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> F:\nEVSVC\Planning Application Forme\Site Approval.(Revised 02-03-10) Page 4 of 4 2012-126 Site Approval.doc <br />