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APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> DescAbe any items of historical or archaeological interest on-site (e.g.cemeteries or structures): <br /> None <br /> Describe any on-site or off-she sources of noise or vibration (e.g.freeway noise,heavy equipment,air.): <br /> HWY 99 West: of project <br /> Describe any on-site or off-sne sources of li-ght of glare(e.p.parking 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 YAII be caused by the project(e.g.numbers of people, housing units): <br /> None <br /> . Tiff 0WMR1qr_TW_ f"6PW%Q%,;NWMM"RW2W eW, WAY ME:AWAOMAMR111 <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 /> 1, further, certify under penalty of perjury that I am (check one). <br /> ,26gal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> 0 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 /> Print Nam: Signature: Date: <br /> Print Name: Y:,fF,,t4 )F6� �AAJ Signature: Date: ods <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F-VEv$VC,Plan,ingAppOra onFom XUsa Peg,(Re isec!09-1048) Page 5 of 9 <br />