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pu+ APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> h T-41 :-.,) <br /> • c P FILE NUMBER: UP- <br /> 4iiFoa <br /> .t §. 7�u '��.t3." t v.: .,,r�-- roa. ..,1h ' t a i �':'j+ ti� t'c.;af1,. ..•.azep. F,,yp s' +a!h-':zr ���3 vN ire`:. �$aY {3n� tx�+`j -u'zihkyFr,.���q,c�'i <br /> OP. _ :Q'.r..t.: ,s. t ,•..r.., e: *1 $.'�,, _�-��,1,�.,✓ah.,t.t`i.:, t, x,: .-c__.�.xie•J -,.':� <br />� <br /> cerrte{eries Describe any.items:of:historical or-archaeolo ical in#erect on-site e: or structures): <br /> Describe any on-site or off-site sources.of noise or vibration e .freewa noise,hbayy.eguiprrfenta etc.).- <br /> Describe <br /> tc. :Describe any on-site or off-site sources of light of glare e.g. parkinglot lighting,or reflective materials used): <br /> i <br /> Describe any on-site or off-site source of odor(e.U.a ricultural wastes): <br /> yvcVo— V— Y'v <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 /> 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: O Cr' C -0- Signature: _�"��. �� � Date: 0 le <br /> Print Name: Signature: �f1.2�. _ E/ Date: Iu u <br /> Print Name: V ���' '� C" r Signature: Date: l o <br /> tel' �-- <br /> Print Name: v5�' Cl-) 6��0 Signature: 7 �'_ ���' Date: 71,1 <br /> d <br /> Print Name: d o 5 C G15 1 a Signature: d 2E' t--��� � Date: :Z&/—,, <br /> FADEVSMPtanning Apptication FormsWse Permit.(Revised 1-2-03) Page 5 of 9 <br />