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�p APPLICATION <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 : <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freewaynoise, heavy equipment, etc. : <br /> Describe an on-site or off-site sources of light of glare (e.g. parkinglot lighting,, or reflective materials used : <br /> Describe an on-site or off-site source of odor(e.g. a ricultural wastes): <br /> Describe'any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> 1 AUTHORIZATION SIGNATURES <br /> ONLY THE OW ER 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 /> ,[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 /> d��� <br /> Print Name: ,IIA 11 Y S. I1 DA.L� Signature: Date: 10I s I c_ <br /> Print Name: J°'4 GS /,t J5&J Signatur Dater <br /> Print Name: Signatu Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSVMPianning Application Farms\Use Permit.(Revised 02-0310) Page 5 of 9 <br />