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Aqu)H <br /> APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> +k "a FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> N <br /> Describe an on-site or off-site sources of noise or vibration(e.g.freeway noise heavy equipment, etc. : <br /> Describe any on-site or off-site sources of light of glare e. . parking lot lighting, or reflective materials used): <br /> Describe anv on-site or off-site source of odor(e.g.agricultural wastes): 6W,l (' <br /> ar� \Son C&Narosy�—f�p2�,25 <br /> Describe anv displacement of people that will be caused by the project e. . numbers of people, housing units): <br /> No-C& <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 /> Ow <br /> 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 /> Print Name:1-r,,r 1��C lff�wa- eA) Signature: -�� Date: �/ / <br /> Print Name: ��tICIQY� Signature: (L.. Date: b �11 / h <br /> Print Name: c" WbIVIIXM5( Signatu Date: Ij <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVCWIanning Application FonnsWae Permit.(Revised 02-03-10) Page 5 of 9 <br />