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APPLICATION - USE PERMIT <br /> �RY s SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> oP. FILE NUMBER: UP- <br /> 9��FORH <br /> Other <br /> Describe any items of historical or archaedo ical interest on-site e. .cemeteries or structures): <br /> O i5 <br /> Describe any on-site or off-site sources of noise or vibration re. .freeway noise heavy equipment,etc.): <br /> 0 <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> A)OJJ 9- <br /> Describe any on-site or off-site source of odor e. .agricultural wastes): <br /> AJ QAJ le <br /> Describe any displace ant of people that will be caused by the project e. .numbers of people,housing units): <br /> o E <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 County arising from 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 Name:CAlZoL L, MEZ'rl..E& Signature: Dater <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />