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APPLICATIGN - USE PERMIT <br /> r' <br /> �a SAN JOA4UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT Jl <br /> • - <br /> FILE NUMBER: <br /> ,r.c ot.fic--.....r.Ra{a7"�`�•-?ir-.+.§3_Ciu Y"e'a�x..2. d,P�-,,;=nttE,eL�.a ys.ax{,�.n'a,'.,,5- k'k'i�"=. -:.� $' ''.xi' spr s.=_,-._ c&r<�tl1Br , ..a d � , UP-hN� f � .g <br /> � m <br /> ' Vi <br /> ME }3 _.,-; 0�d. <br /> : <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> None <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freeway noise,heavy equipment,etc. : <br /> None on site. off-site noise comes from the cars on Lower Sacramento Rd. <br /> Describe an on-site or off-site sources of li ht of glare (e.g.parkinglot lighting,or reflective materials used): <br /> To avoid lare directed lightening sources will be used outdoor in the parking lots and new buildings. <br /> Describe an on-site or off-site source of odor(e.g.agricultural wastes): <br /> None <br /> Describe an displacement of people that will be caused by the project(e.g. numbers of people,housing units): <br /> None <br /> AUTHORIZATION SIGNATURES <br /> ONLY.:THE OWNER`OIF.:THEII°ROPERTY OR g � L <br /> ANAUTHORIZED�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. ,A, JJ '' <br /> Print Name: Mo 1{A lAR9 J4DIl Signature: /A-, r�C ` Date: 12— 18- 03 <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> FMEVSVC1Planning Application Forms\Use Permit(Revised 1-2.43) Page 5 of 9 i <br />