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°q `° APPUCATION - ENTERTAINMENT PERMIT <br /> 2.' .:—c'r-r.'1 <br /> "' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • �d�)FORN`4 FILE NUMBER: <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): <br /> hJ <br /> Describe <br /> /any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment, etc. : <br /> Describe any on-site or off-site sources of light of glare (e.g. parkinglot lighting, or reflective materials used): <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> .AJ 11A <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 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. ���r <br /> Print Name: ���� hi SAWat' Signature: ,�dW/J'Uete: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVOPlanning Application Fonns\Entertainment Permit.doc Page 6 of 10 <br /> .(Revised 05-09-08) <br />