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'oe '4 APPLIGATON - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Describe any items of historical or archaeol ical interest on-site. e. cemeteriesor structures <br /> Describe any on-site or off-site-sources of noise or vibration(e.g.freeway noises heavy a ui ment,etc.): <br /> WITBIN 5Z, To G IHT <br /> D S <br /> rDescmdbe <br /> any on-site or off-site sources of light of iare e. .parkinglot li hbn ,or reflective materials used): <br /> ore-site or offsite source of odor e. .agricultural wastes): # <br /> ©ascribe any displacement of people that will be caused bX the project(e.q.numbers of people,housing units <br /> AUTHORIZATION SIGNATURES <br /> ONLY-THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT'MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnity, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner, ent'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 /> i <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 /> I <br /> Print Name: , Signature. Date. <br /> Print Name: Signature: ) Date: <br /> Print Name: Signature: fi Date: <br /> F Uame: Signature: t <br /> Date: <br /> Print Name: Signature: Date: <br /> 1, <br /> i <br />