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°¢4u1 APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> �1�oRN <br /> f <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): <br /> �o � <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used): <br /> N o..1 e <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> Describe any displacement of peOple that will be caused by the project(e.g. numbers of people, housing units): <br /> r <br /> .AUTHORIZATION SIGNATURES <br /> ONLY T.HE OWNER 0F'.THE PROPERTY OR AN AUTH0RIZED`'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. <br /> Print Name: + nci Signature: Date: 2 S f <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> t Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSV0Planning Application Formsl Site Approval.(Revised 05-11-09) Page 5 of 9 <br />