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0.c,h APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �.. FILE NUMBER: OF <br /> Other <br /> Describe any items of hkk0cal or!MhR22Wcal Interest on-site e. .cemeteries or structures <br /> Previously assessed in ER-93-1. <br /> Describe any on-site or off-alta sources of noise or vibration e. .freeway raise hea equiprnent,etc.): <br /> See attached project description. <br /> Deeaibe any on-site or off-site soutm of§It2t2bm e. .paricing lot Ilghft,or rermaikye materials used): <br /> See attached project description. <br /> Describe any on-site or off-site source of odor e. .2&riaLftural wades): <br /> See attached project description. <br /> Describe ww displacernent of that will be caused ty the pMed e. .numbers of housing units): <br /> one <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 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 /> q OF <br /> print Nam. Michael K. Repetto Signature: Dom: 12/20/2007 <br /> Print Name: Signature: Data: <br /> print Name: Signature: Date: <br /> ^•int Name: Signature: Date: <br /> �fnt Name: Signature: Date: <br />