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46- 1 <br /> APPLICATI USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> b <br /> 7 <br /> 0 <br /> Describe any items of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment, etc.): <br /> Nam <br /> Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor(e,q. agricultural wastes)- <br /> Describe any displacement of people that will be caused by the prpject(e.g. numbers of people, housing units): <br /> J <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> 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 /> .. Po C,E R <br /> Print Nam Date: 12o <br /> Print Name: SfaL D A Akifi4AP—1 Signature: Date: f 2 20 0 <br /> Print Name: Signature; Date: <br /> Print Name: Signature: Date: <br /> Print'Name: Signature: Date: <br /> FADEVSVOPlanning Application Forms\Use Permit.(Revised 1-2-03) Page 5 of 9 <br />