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O ft(�Ulry O <br /> APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTIv1ENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> ✓Wl'�SL' <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heayy equipment,etc. : <br /> 1nb'�Z, <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 dis lacement of people that will be caused by the project e. . numbers of pe021e,housing units): <br /> ------------- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> E_ <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 <br /> /and correct. <br /> s" . <br /> Print Name: µ VI' n nCAt�f(/. Signature: <br /> Print Name: V1Vl C- �xluC� Date: �r�IT /,� <br /> Signature: Date: d I I ' �_ <br /> LPrint <br /> Name: Signature: Tri <br /> Date:-- <br /> Print <br /> ate: _ <br /> ame: Signature: <br /> Date: _ <br /> ame: Signature: <br /> Date: <br /> F:IDEVSMPlanning Application Fortes\Site Approval.(Revised 02-03-10) Page 5 of 9 <br />