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W� <br /> c° APPLICAT161 i -- USE PERMIT <br /> ki <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> w <br /> FILE NUMBER; UP- <br /> W, <br /> P-W <br /> Sp J'4 J!i 4 9 $•�I }•J 4r`":•'�wl�r 4,A: p:+�xZ .1 `. _5 L F V !'- {12' t54}v.�} y..r J F T -..carr ir'.} <br /> _ a.��.�`f Pc��'�.,t•u3 ,�-�'���t,_.l:�i� '�..�''.. k,:.��a „�'���.��Oth@ry �iu�?2.�rJ'>� ��F��`a�t� ��' 't��;u�'�''�-�.--:.'��`�`�����`'f�4�.� ��"��' ��, <br /> Describe any items of historical o�archaeolo lcal.interest on-site.(e.g.cemeteries or structures <br /> .. <br /> Describe an on-site or <br /> off-site sources of noise or vibration' e. .freewa noise heavy a uE ment <br /> ,etc. - <br /> , <br /> y� S TP-Oc, TAF L <br /> Describe any on-site or off-site sources of light of glare(e.g. arkin lot lighting,or reflective materials used). <br /> Describe any on-site or off-site source of odor <br /> (e�e.AA.a ricultural wastes), <br /> Describe any displacement of people that will be caused by the project(e.g.numbers of people,housing units <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> F <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 /> 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 Nam /Q,¢GG (.(� �iQ✓V�� Signatury� Dater / <br /> Print Name: Signature: Date. <br /> Print Name: Signature: - Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVC1Ptanning Application FormsWse Permit.(Revised 1-2-03) Page 6 of 9 <br />