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APPLICATION - USE PERMIT y { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT . `P.. FILE NUMBER: UP- R . FQ�� Other Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): A search of cultural resource records was obtained from the Central California Information Center at CSU, Stanislaus. No cultural resources have been recorded on or in the immediate vicinity of the project site. Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy equipment, etc. : Project operation will not involve any substantial noise. Describe any on-site or off-site sources of light of qlare (e.g. parkinglot lighting,or reflective materials used): Project operation will not involve any sources of light of glare. Describe any on-site or off-site source of odor(e.g. agricultural wastes): Project operation will not involve any source of odor. Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): The project would not adversely affect existing community services or cause any changes in demand for services. Fire&emerge c Services will be enhanced by the project. The project will involve no adverse affects on socioeconomics. AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. 1, the Owner/Agent agree; to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. I, further, certify-under penalty of perjury that I am (check one): ® Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application, or ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and have been authorized to file on their behalf., and that the foregoing application statements are true and correct. l ! Print Name: Chief Butler Signature: s Date: + Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: I F:IDEVSVCIPIanning Application Forms\Use Permit.(Revised 02-03-10) Page 5 of 9