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^r. rQ�Q�+N o � i• 4 � <br /> j. APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I " <br /> c�.. .FILE NUMBER: :UP- <br /> `ni.:•'%al�,..ti.{�' .iKe !X.{ <br /> Describe any items of historical or archaeological interest on-site e. ..cemeteries or structures <br /> + -Describe any on-site or off-site sources of noise or vibration le.6.freeway n-61se,'heavy aqui meet,etc.): <br /> Describe any on-site or off-site sources of light of glare(e.g.parkinglot lighting,or reflective materials used : <br /> v .(� G F�f-e n "'7 $J u b O&C l,(4.wa <br /> 1 Lp __.` i4-rir3(o Q—AflLe9 - ` <br /> Describe any on-site or off-site source of'odor e. .a deultural wastes <br /> OP <br /> Describer4riy displacement of people that will:be caused by the ro'ect•(e.g.numbers of pi o le;ftWsiin units <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION.- <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ❑ Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) t : <br /> involved in this application, or <br /> y ` egal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> I application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name:`>-)U 15 (A60 Lc 0 Signature: f ate: 6 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\0EVSVCNPIanning Application Form$\Use Permit.(Revised 1-2-03) a 1. Page 5 of 9 <br />