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APPLICATION --- USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> '�Yi�"SiiiN <br /> _ Otlter <br /> Desaibe an items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> None to our knowledge- <br /> Describe an onsite or off-site sources of noise or vibration e. .fieewa noise hea u' mens,etc. <br /> None to any extent of- concern. <br /> Describe!M on-site or off-site sources of light of glare a ..pariiing lot lighting.or reflective materials used): <br /> X111 site lighting will be directed inward toward the <br /> property. Excessive glare is not expected. <br /> Describe an on-site or off-site source Df odor e. .acricuftural wastes. <br /> a None to any extent of concern. <br /> Describe any displacement of people that w1I1 be caused by the proe.g.numbers of people,housing units): <br /> None . <br /> AUTHORIZATION SIGNATURES <br /> :.ONLY THE.:OWNER-OF THEPROPERTY OR.AN.AUTHORIZED AGENT MAY FILE:AN APPt:ICATION. <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 County arising from the Owner/Agent's project. <br /> 1,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: 1fV✓5T0A✓ Signature: Date: �r <br /> Print Name: Signature, Date: <br /> Print Name: Signahae: Date: <br /> Print Nanw. Signature: Date: <br /> Print Name: Signature: Date: <br /> F3DEVSVCUnanning AppSraboa FommlUse Pem9L(Ronssd 02-03-10) Page 5 of 9 <br />