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APPLICATION -- USE PERMIT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: UP- Other Describe any items of historical or archaeological interest on-site (e.g. cemeteries or structures NIA— No historical or archaeological interests on-site. Describe any on-site or off-site sources of noise or vibration (e.g. freeway noise, heavy equipment, etc.): NIA - None Describe any on-site or off-site sources of light of alare e.q. parkinglot lighting, or reflective materials used): All lights will comply with the local lighting ordinance. All lighting will be directed toward grade and contained within the property boundaries. Describe any on-site or off-site source of odor(e.g. agricultural wastes): NIA—All waste will be pumped and removed. Describe an displacement of people that will be caused bthe ro ect e.2 numbers of people, housing units NIA AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. I, further, certify under penalty of perjury that I am (check one): Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application, or ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and have been authorized to file on their behalf., and that the foregoing application statements are true and correct. Print Name: Dip 11— Signature' � t c� � �j ,�'l.. �� Date: Print Name 1Ct1 e�-e ti�&- >r ;i �— ti Signa#ure: - ,r r Date- 2- Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F:�DEVSVCSPlanring Application FormsWrw Permit.(Revised D2-03-1M Page 5 of 9