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r <br /> ' aAPPLICATION — USE PERMIT � <br /> P:. <br /> <i SAN JOAQUIN ri UN b C O€vMUN1 v DEV i -!pili EN T DEPAFTe/ENT <br /> FILE NUMBER: <br /> UP-Other <br /> s QCSG'IbE arty rW"rr:$i3?'ti:sior.Cal or �e �i cr nt.' i+. IF? 0 <br /> s <br /> NO <br /> S^fine flr'y OM&iia or Cd-Site Sour es ni no'^e or yibis ian je tree, ay.naspl heavy eqt ipmert etc-r <br /> 1 # <br /> li <br /> is D3SCiihe anv on-'s'te Kar off,9+e Slumee p'i. PEL Gt icrs i t <br /> a 9' e.c;.parking iG.light nia,ar re8t5c ye maL-riais <br /> d n <br /> none- <br /> el <br /> _ <br /> i`'_D� l any an-site or off-she Sou e Gf o:,!Gr 1 c,c agrivilturai+nasus): _ <br /> u `Jesc^ba a;ty displa+.,went of:> A1e ihei li(i be Mused p7 the ara;act(e.'-numbErs o`p=o6:2,f10U3iR^.,unita-`t: <br /> Ij c <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AdJT'HORIZEDl AGENT MAY FILE AN APPLICATION. <br /> I the DhrneriAgent agree, to defend, indemnify, and nolo harmless the County and its agents, officers and <br /> !.. employees from any claim, action or preceeding against the:runty arising irurn the Dwner,'Agents project. <br /> p 1, <br /> further, certify under penalty of perpury t"sea[1 am(check one): <br /> x, Legal property owner(owner includes:.acinar, trustee, Vustor, or corporate officer)of tha property(s) u <br /> involved in this appiiication, or <br /> 19t <br /> 71 Legal agent(mach proof of the owner's consent to the application: of the property's involved in this <br /> application and have been authorized to me on their hehalf., and that the foregoing application statements <br /> are true and correct. <br /> r _ .. <br /> @ print Nama: 0. _-___ Signatura. _, o aaYe: <br /> r <br /> „p - --- <br /> print Marne: _..__!„ 0 delcln.. $fgn gra: Dale: - <br /> __ _ _ ._ -- <br /> p <br /> Prim Name: _ signature: Late: <br /> Mini Name: si ature� Date: <br /> Print Neme: Signature: Date: .__..._._.._ <br />