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rqU � APPLICATION - SITE APPROVAL <br /> 3.• '.O <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> EV <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment,etc. : <br /> ` � w <br /> 'bv1'� 1��/"�� '�. 1� �,.�.�tf�.lC 1 • r.�� �' �Rte."` <br /> Describe an n-site or off site sources of light of glare e. .parking lot li htin , or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> VJU <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units)- <br /> AUTHORIZATION <br /> nits :AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 t eir behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Signature: Date: Z <br /> Print Name: Signature: Date: <br /> Print Name- Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature.. Date: <br /> F:IOFV9VC1Planning Application FormsiSite Appsnval.(Revised 02-03-10) Page 5 of 9 <br />