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C,° APPLICATION - SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> P FILE NUMBER: SA- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> C) <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment, etc. : <br /> iZt C j� V c dSi✓Z,A��ce— w►'max t'� >t "i �3 v C��r C t� ..�� ICS Z_`� Cz <br /> L <br /> t 1.4tjvJtZS t t�� Y H <br /> '� �t <br /> �� <br /> 4 <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot 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 /> 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 /> Lo-tegal 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 beh nd th the foregoing application statements <br /> are true and correct. <br /> ' <Y <br /> Print Name: Signature: l >�'K"� Date: <br /> Print Name: E: Signature: Date: > �' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 17 nol PnnP 1i of Q <br />