SU0007105 - Laserfiche WebLink

Home Browse Search

l�l C APPLICATION - USE PERMIT y yid d SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT c ;. FILE NUMBER: UP- �%FOPS � n Other _ I Describe any items of historical or archaeological interest on-site e. .cemeteries or structures f�oNE i Describe an on-site or off-site sources of noise or vibration e. .freewaynoise,heavyequipment,etc. : I�NrtinP `T0e- TP—UtLK— rN F—S Describe any on-site or off-site sources of light of glare e. .parkinglot lighting,or reflective materials used): I {{�_V_% Al !Iil c-r+iT, � i Describe any on-site or off-site source of odor e. .agricultural g wastes : DNS r Describe any displacement of people that will be caused by the prolect e. .numbers of people,housing units Q �. c51 N In I_c- t• 1 Lv �S i (��N� 6J>l'lF}-Ll., �/Vf.OL/5/-1� � AUTHORIZAT�Q'1��SIG'NATI�R 'S ONLYaTHE OWNER OF.,a7HEPR'QPERTY,`OR AN QUTHORIZED'AGENTF�LE,AN APPLICATION: . I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and I employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. f I, further, certify under penalty of perjury that I am (check one): i Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) involved in this application,or j ❑ 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 I, correct. Print Name: l 'Q y � { ' �� Date: 09 } Si - I Print Name: nature: Date:— Date:9 Si Print Name: 9 Print Name: Signature: Date: Print Name: Signature: Date: FIDEVSVMPlanning Application FonmsWse Permit.(Revised 05-11-09) Page 5 of 9 I