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APPLICATION -- SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER. SA- <br /> Other <br /> Describerana archaeological interest on-site e. .cemeteries or structures : <br /> Describes of noise or vibration e. .freewanoise,hea a ui ment, etc.): <br /> Describe an on-site or off-site sources of li ht of glare e. arkin lot <br /> rlighting,or reflective materials used): <br /> IK LtJ <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> Describe an pd�is lacement of eo le that will be caused b the ro'ect(e.g. numbers of people,housingunits): <br /> t✓ <br /> AUTHORIZATION SIGNATURES <br /> r1, <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 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 /> 1, 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. J, ��Jj� <br /> Print Name: ICJ �1 6y[ S J Signature- Date: <br /> Print Name: Signatur Date: <br /> Print Name: Signature: Date: <br /> Print Name: _ Signature: Date: <br /> Print Name: Signature: Date: <br /> F:10EVSV0Flanning Application Fon-nslSite Approval.(Revised 02-03-10) Page 6 of 9 <br />