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COO <br /> APPLICATrUN — USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- - <br /> Other <br /> Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures): O*JE <br /> Describe any on-site or off-site sources of noise or vibration (e.p.freeway noise, heavy equipment, etc. : <br /> 5T 2l� <br /> Describe any on-site or off-site sources of light of glare (e.g. parking lot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g.agricultural wastes): V'IOt.JC <br /> Describe any displacement of people that will be caused by the 2roject(e-q. numbers of people, housing units): UOtJE <br /> AUTHORIZATION SIGNATURES <br /> 1 <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: _ Signature: Date: Z— w <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: _..,_. _ Date: <br /> Print Name: Signature: Date: <br /> F 0EVSVMP1ann1ng Application Forms\Use Permit(Revised 1-2-03) Page 5 of 9 <br />