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APPLICATION USE PERMIT <br /> �,,F t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> fi <br /> FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e.g cemeteries or structures)7 <br /> NONE <br /> Describe any on-site or off-site sources of noise or vibration(e.g. fteeway noise heavY equipment,etc. <br /> RELIGIOUS FESTIVAL ACTIVITIES <br /> Describe any on-site or off-site sources of light of glare e.g parkin lot lighting, or reflective materials used): <br /> NONE <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> NONE <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units)7 <br /> NONE <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 /> VLegal agent(attach proof of the owner's consent to the application of the propertys involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application <br /> statements are true and correct. <br /> Print Name: I I KOSAI I A Signature: Dam <br /> Prod Name: Suture: <br /> Dab <br /> PrirR Name: <br /> Signature: <br /> Prird Name: Signature: DA- <br /> -Print Name: <br /> Sgnature: Cale: <br /> F.NDEvsVCTte APP6 rai Fa k use Pd iL(Rev'sed 02u3-10) Page 5 of 9 <br />