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/22/05 13: 26 FAX 209 942 4 Siegfried Ens vv WJuuo F, c <br /> APPLICATION -IAtAk(*�JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: 4°f 151� <br /> Describe ah items of historical or archaeological interest on-silo(9.2.cemeteries or structures): <br /> None <br /> Describe any on-site or off-silo sources of noise or vibration(e.g.freeway noise,hea ui ment•etc.): <br /> Nojae <br /> Desenbe anY on-site or off-site sources of light of glare(9.9.paikinglot fighting.or reflective materiats used <br /> General yard lighting, <br /> Describe any oo-site or off-stte source of odor e. .agricultural wastes): <br /> None <br /> Describe anv displacement of people that will be caused by the proiect(e.g-numbers of people.housiLi2 units): <br /> None <br /> AUTHORIZA►TI.QW S.1.Gi�FAT. R z•}x" ; y `. j <br /> Ftpy111�1EEWF T"E PROPERTY OR-AN.ApTHORIZpD-.AGE?iT;MAY FILE <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 /> 1, further,certify under penally of perjury that I am(check one)_ <br /> �pLegal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s) <br /> involved in this ap�licatigp or <br /> Legal agent (attach proof of the owner's consent to th application of the property's involved in this <br /> application and have been authorized to file on their b alf.,and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Dale; <br /> Signature:Si9 2 <br /> Print Name: Signature: Date: <br /> Print Nerne: Signature: Dale: <br /> Print Name: Signature: Date: <br /> Print Name: Signolure_ Dale: <br /> F1DEVSVC-P1sru*w Apo"Ilan FamulUse Permit-(Rovif.W"3-64) Page 5 of 9 <br />