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°p0.: APPLICATION -- SITE APPRO AL <br /> { - SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA- <br /> P. <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures).- <br /> Describe <br /> tructures :Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, hea equipment, etc. <br /> Describe any on-site or off-site sources of light of glare(e.g. parkia2lot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> IVIA <br /> A <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 /> Briegal 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 /> 42 <br /> Print Name: gnature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />' POEVSVCLPlanning Application FormslSite Approval.(Revised 09-10-08) Page 5 of 9 <br />