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APPLICATION - SITE APPROVAL <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. .cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g-freeway noise,heavy equipment,etc. : <br /> Describe any on-site or off-site sources of light of glare e. .parlang lot fighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e-q.agricultural wastes): <br /> Describe any displacement 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 pro1ect. <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 state ants <br /> are true and correct. <br /> Print Nam t/UN:I Sign ure: Itiir Date: i, <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date:___ —_ <br /> F:VEVSVC%Planning AppUmfion Forms\SHe Approval.(Revised 02-03-10) Page 6 of 9 <br />