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0411bi*J-� <br /> APPLICATION - 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. .cemeteries or structures): N/A <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment,etc. : N/A <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting,or reflective materials used <br /> Describe any on-site or off-site source of odor e. . agricultural wastes): N/A <br /> Describe any displacement of people that will be caused by the project e. . numbers of people, housing units): N/A <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 County arising from the Owner/Agent's project, <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ❑x 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: DHARAM SINGH signature: Date: 01/28/16 <br /> Print Name: Signature: Date: <br /> Print Name: NN11 Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F1DEVSVOPlanning Application Forms\Use Permit.(Revised 02-0370) Page 5 of 9 <br />