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}. APPLICATN - USE PERMIT' <br /> .� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Other <br /> FDescriben items of historical or archaeol ical interest on-site(e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration!Le.g.fteewa. noise,hea a ui ment,etc. - <br /> Ary, <br /> Describe any on-site or off-site sources of light of glare.(d.g.parkinglot li htln ,or reflective materials used)- <br /> '06 <br /> se :N6 <br /> Describe iM on-site or off-site source of odor Le.k.Nricultural wastes): <br /> Ki�T iN ik <br /> Fdbedisplacement of ea le that will be caused b the project e. .numbers of people,housingurirts <br /> AUTHORIZATION.. SIGNATURES <br /> E OWNER OF THE PROPERTY OR AN AUTHORIZED.AGENTMAY FILE AN APPLICATION. <br /> r/Agent agree, to defend, indemnify, and hold harmless the County and its agents, offcers and <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> ertify 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 fcforrect. <br /> Print Name: R I CI�c. ST UyT Signature: Date: <br /> Print Name: Signature: Date: 1110 <br /> Print Name: <br /> Signature: pate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FMEvsv6pianning Application Formsluse PermiL(Revised 05-11-09) Page 5 of 9 <br />