Laserfiche WebLink
APPLICATION - USE PER <br /> K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �. ..P FILE NUMBER UPF� }1�(1 !- — <br /> 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. .freeway noise,heavy eq ui ment,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 gidse(e.g.parkinglot 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 /> i <br /> i <br /> Describe any displacement of people that will be caused by the promect(e.g.numbers of people,housing units): <br /> None <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> i <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the (',ounty 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 Lander 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 /> � <br /> Print Name: ya) c-,6 ra 1--r r�r�s� 'Signature: Date:61,3 01,1D I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVOPlanning Application FormsWse Permit.(Revised 02-03-10) Page 5 of 9 <br />