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air^ APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> Other <br /> �- Describe anv items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> I.ION� <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise, heavy equipment,etc.): <br /> Describe anv on-site or off-site sources of li ht of glare(e.g.parldng lot li htin ,or reflective materials used): - <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes <br /> Describe an die lacement of people that will be caused by the-project e. .numbers of peopie,housing units): <br /> Noah <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 project. <br /> i,further, certify under penalty of-perjury that I am-(check one): <br /> 14 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 I <br /> are true and correct. l <br /> Print Name: ` 0.9 nature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: _ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSMPlanning Application Fonns\Site Approval.(Revised 02-03-10) Page 6 of 10 <br />