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_== = APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> 1 FILE NUMBER: UP- <br /> Other <br /> DescMe any OBnB aflildmil la linterest on-site e. .cemeteries or struWnes: <br /> 4 <br /> Describe any on-aft or off-sib sources of noise or Wwadorr e_g fteeway noise,heavy equprnenL etc.: <br /> 1 <br /> Desaihe any on-site or off-site sounxs of fight of 9Lare(e.g.parking lot Fighting,ar reflective materials used <br /> Describe any ori, M or oR-sle source of odw e. .agftultural wash-s: <br /> Dnbe nt of people bud wil be cau�U by the numbers of people,housing units.' <br /> Al Z,ii,f7 <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN 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 /> employees from any claim, action or proceeding against the County arising from the Owner/Agent's project- <br /> 1, <br /> rojectI,further, certify under penalty of perjury that I am(check one): <br /> ❑ Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of Ute 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. ,� f <br /> Print Name: b v Signature: Date: / 2S-fL <br /> Print Name: <br /> Signature: Date: ►' 2 1 Z <br /> Name: E7 tv <br /> Print ''rJ /"`�tf- <br /> U K f"1 DS stsnature: Date: 1►• ZZ•,Z <br /> Print Name: Signature: Date. <br /> Print Name: Signature: Date: <br /> P YA"ftW=FwnstseAna (wised02-03-to) Page 5of9 <br />