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v <br /> Ut" APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT � <br /> FILE NUMBER: UP- <br /> ;rFtl� - <br /> t z"Other - <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc. : <br /> Freeway noise on Highway 99 and Eight Mile Road, both of which are adjacent <br /> to site. <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used): <br /> Nonei <br /> I <br /> Describe a ny on-site or off-site source of odor(e.q.agricultural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project e. .numbers of peoele,housing units): <br /> None <br /> AUTHORIZATION.:S`IGNATURES , ... l <br /> r - <br /> ONLY THE DWNER OF THE PROPERTY ORAWAIT' HOR1ZE©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 /> ® 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 /> owar . e <br /> Print Name.Hd LSll 9 Signatur I `Date: 20L1 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RMEVSMPlanning Application FormslUse Permit.(Revised 02-03-10) Page 5 of 9 <br />