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APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i•t <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of his r' 1 or archaeological interest on-site(e.q- cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, eavy equipment, etc. <br /> K'o,wd <br /> a k 1AfeV5b9L71,ok <br /> Describe any on-site or off-"t sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> O �ff <br /> Describe an displacement or wele that will be caused by the project(e.g.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 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 prop 's involved in this <br /> application and have been authorized to file on their behalf., and that the for o' g application statements <br /> are true and correct. <br /> Print Name: \0.h C�q2\ Signature: Date: -y"67 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />