Laserfiche WebLink
Y <br /> °Pg�IN. APPLICATION - USE PERMIT <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c +!P FILE NUMBER: UP- <br /> 9�/FORD <br /> Otl L ler <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> /Vo <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise, heayy equipment, etc. : <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting,or reflective materials used): <br /> Z CE <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> �C <br /> Describe any displacement of people that will be caused by the ro'ect e. . numbers of people, housing units): <br /> lv2i AI-E <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 /> 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: k`6&F;L.7' 7AC-5/oN Signature: Date: 3lr� <br /> Print Name: 1111voe/LIll 7A6S10/V Signature: Dater <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FIDEVSMPlanning Application For s\use PenniL(Revised 02-0310) Page 5 of 9 <br />