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op4U'µ APPLICATION SITE APPROVAL <br /> �,.�,Cp <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Edi 7Fi-t'�P FILE NUMBER: SA- <br /> pLseoof <br /> Other <br /> f historical or archaeolo ical interest on-site e. cemeteries or structuresr off-site sources of noise or vibration e. .freewa noise hea a ui ment, etc. : <br /> r off-site sources of li ht of glare e. . parking lot li htin ,or reflective materials used): <br /> liqln-fiw <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> Describe any dis lacement of people that will be caused bv 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 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 /> Pr"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. <br /> Print Name: Signature: — Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F TEVSVC\Planning Application Forms\Site Approval,(Revised 1-3-03) Page 5 of 9 <br />