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APPLICATION SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPrAENT DEPARTMENT <br /> FILE NUMBER SA- <br /> Other <br /> Describe any items of historical or archaeological Enterest on-site e q. cerneteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration e c treeway noise, heavy equipment. etc.). <br /> None <br /> Describe any on-site or olf-site sources of light of glare (e.g. parkn2lot li htin . or reflective materials used <br /> Parking Lot Lighting <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 praievt e.j. numbers of people, housing units . <br /> None <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 /> ❑ 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. Tim Pollock Signature Date. 7 <br /> Print Name: Signature Date: <br /> Print Name, Signature Date <br /> Prini Name- Signature: Date- <br /> Print Name. Signature: Date: <br /> F QFVSVCG Plann,ng Appl'cat:on FormstSetP_Approval Revised 5-D3-04j Page 5 of 9 <br />