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'• r' __ ' N <br /> " ° • }�` APPLICATION -- USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />! <br /> i <br /> cdt�FONT'�P FILE NUMBER:'UP- <br /> Describe an 'items of historical or archaeolo lcal interest on-site. e. .cemeteries or structures): <br /> N.6N� <br /> Describe any on-site or off-site sources of noise.or vibration e. .freewa .noi","heayy equipment,etc. : <br /> Describe any on-site or off-site sources bf.li `fit of glare e. .parkinlot li htirt ,or.reflective materials used): <br /> aN�_ <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people, housing units): <br /> 0 <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY ORAN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> i 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 /> O/Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> F 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: kc Signature: . Date: r 1( -6 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i Print Name: Signature: Date: <br /> i <br /> F.IDEVSVCTlanning Application FormslUse Permit.(Revised 1-2-03) Page 5 of 9 <br />'r <br />