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° c APPLICATION — SITE APPROVAL <br /> y.p,,,. 41 •K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any Items of historical or archaeological interest on-site e. .cemeteries or structures): ' G` <br /> Describe any onsite or off-site sources of noise or vibration e. .freeway noise,hea a ui ment,etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): -X G. <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): W jn <br /> Describe any dls lacement of people 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 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 /> Q/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 t he f gaing application statements <br /> are true and correct. {� <br /> Print Name: K (Signature: I Date: 3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RMEMC\Planning Application FonnslSite Approval.(Revised 02-03-10) Page 5 of 9 <br />