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APPLICATIC?''�?- USE PERMIT <br /> SAN JOAQUIN COUNTY COM MUNITY'DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP-- <br /> Other <br /> I <br /> Describe any items of historical or archaeological interest on-site(e.g, cemeteries or structures): 1�an e- <br /> Describe any Dn-site or off-site sources of noise or vibration e. .freeway noise, heavy equipment, etc. : Pum]p <br /> and -{-ruck C�r ine5 f <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): Pa.�L (11m,\ <br /> lo{— (i tL vl q <br /> � J <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): tJbn <br /> 3 <br /> Describe any displacement of peo2le that will be caused by the protect(e.g. numbers of people, housing units): O n.e- <br /> sin le PamJt esidence. (.vi (( 6e J6rno(-; sk-CA . <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 /> 1, further, certify under penalty of perjury that I am (check one): <br /> YL� 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: '{/3 {J R S I<-6t` lature: Date: 3 - Zo-U 8 <br /> Print Name: o Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVDPlanning Application Forms\Use Permit.(Revised 1-2-03) Page 5 of 9 <br />