Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION - USE PERMIT <br /> SAN.lOAQUIN COUNT(COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> O <br /> e <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> acG <br /> Describe any on-site or offsite sources of Fight of glare e. .parkiN[at righting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.A.agricultural wastes <br /> �c 0e.�S <br /> Describe any displacement of e2ople that will to caused by the prcect e. .numbers of people,housing units). <br /> A101V1z- <br /> -PR <br /> OW YTFfe OWNER,OIr,�ME3P.,ROPERTY OR ANS AUTHORIZED AGENTMAXF.„1L-lEIIAW roftiCATiOM.W <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 /> 1,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 <br /> orrectPrint Name: ,�C� _�n`1 �' Signature: Date- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSViMPlanning AppOwOon Fonns%Use Permit.(Revised 02-03-10) Page 5 of 9 <br />