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APPLICATION - SITE APPROVAL <br /> LmgiL <br /> t <I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> /! <br /> FILE NUMBER: SA- <br /> *�fFO�_�' <br /> Other <br /> Describe any items of historical or archaeological intereston-site (e.g.cemeteries or structures): <br /> None known. <br /> Describe an on-site or off-site sources of noise or vibration e. .freeway noise heavy equipment,etc.)i <br /> Tractor noise from surrounding fields. Cars moving on Linne Road <br /> Describe an 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 Ce-g.agricultural wastes): <br /> None <br /> Describe any displacement of ole that will be caused by the project e. . numbers of people, housing units <br /> None <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. p <br /> Print Nam . Signature' pate 10 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F'.DEVSdC)Plannmg r,ppkamn Forrn�shB Appmai.(Re,isx 02-03-10) Page 5 of 9 <br />