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°P APPLICATION — USE PERMIT <br /> T v� <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ��. FILE NUMBER: UP- <br /> Other <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 /> Nos2 vibrOcklon w10 Aae mnmoi <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting,or reflective materials used): <br /> Newtr` ko 4 h <br /> I Ili 1i <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> Novve on s 1k C)d s . �-" rn an ctai &(-cQrk - <br /> Vic title l a <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> NJA <br /> AUTHORIZATION SIGNATURES <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 /> I, further, certify under penalty of perjury that 1 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. J/, <br /> Print Name: f /?]2,E V I< fI AI 0� Signature: A6 ��-� �zg;z �� Date: Q—JPS-S <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Forms\Use Permit.(Revised 1-2-03) Page 5 of 9 <br />