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FROM (THU)RPR 9 0009 6:0( 9:68^40.7613900076 P G <br /> APPLICATION - SITE APPROVAL <br /> ;€� Al. . <br /> 14: SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c... FILE NUMBER: SA- <br /> 7 r7 <br /> heF r <br /> Describe any items of historical or archaeological interest on-site(e,g_.,cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway nolse, heavy equipment,etc. : <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or refieclive materials used): <br /> Describe any on-site or off-site source of odor(e.g.a ricu{tural wastes): <br /> Describe any displacement of people that will be caused by the project e. .numbers of people,housing units): <br /> AUTHC I �ZaTi:C3N'siGNA,TL FSE' <br /> ONLY-fit QWNM'.QF TRE PROPERTY ORAN:AUTH0R1ZED AGENT FfL�AN APP LIC ATION. <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:III m CJV 5 679 tGI S GI�Slgnature: �� pate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: date: <br /> F10EVSMPlanning Application Form4SIte Approval.(Revised 09-10-09) Page 5 of 9 <br />