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.t - <br /> qurh <br /> APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r4• :P FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> None <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc. : <br /> None <br /> i <br /> Describe any-on-site or off-site sources of light of 2care(e.g. parkinglot lighting,or reflective materials used)- <br /> None <br /> sed :None <br /> Describe any on-site or off-site source of odor e. . a ricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the prpject(e.q. numbers of people, housin units : <br /> None <br /> s <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 /> 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 h <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. k <br /> I: <br /> Print Name$ ; �; ( Signature: OfDate: -7- 0 8 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVMPIanning Application FormslUse Permit.(Revised 6-03-04) Page 5 of 9 <br />