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APPLICATION - Si-et 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.g.cemeteries or structures): <br /> None known <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.); <br /> None <br /> Describe any on-site or off-site sources of light of glare(e.g,parking iot lighting,or reflective materials used): <br /> Off-Site Lighting g g N/A _ <br /> On-Site Lighting N/A <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project(e.g•numbers of people,housing units): <br /> Vacate house to be demolished <br /> A T O O S A R S <br /> f <br /> { <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 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 /> L <br /> 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 statement <br /> Legal <br /> true and correct. <br /> Print Name: Signature: a `� <br /> Date: <br /> Print Name: /,�`�, //_e C° elt/i Signature: t Date: a l !! <br /> Print Name: Signature; <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> F%DEVSVC11PlanWng Application FormsUSite Approval.(Revised 6-03-04) Page 5 of 9 <br /> II <br />