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p4Urry APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> 'FOF <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> t11J VV <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> Describe any on-site or off-site 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 /> Describe any displacement of peopie that will be caused by the project e. . 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 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. 1 <br /> Print Name: T7 1� t"A Signature: Date: <br /> Print Name: _f`41, V Kkt-2 .I1-,t,h Signature: Date: Into! if <br /> Print Name: -Atli ve\jJ K �`4r) _ Signature: <br /> Date: <br /> Print Name: so ri Signature+( <br /> Date: 1 /iU/t} <br /> Print Name: _ _ _ Sign ure: ��Ul t <br /> Date: t f <br /> F:1eEV3VOPlanning Applicatlon Forms4Slte Approval.(Revised 02-03-10) Page 5 of 9 <br />