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APPLICATION <br /> 'i - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t FILE NUMBER: UP- - <br /> 9{iFo#� <br /> Oth8r <br /> Describe an items of historical or archaeological interest on-site(e.g. cemeteries or structures <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freeway noise,heayy equipment, etc. : <br /> �Y, 1�eQ r <br /> Describe an on-site or off-site sources of fi ht of fare e. arkin lot li htin ,or reflective materials used <br /> �Y7e- <br /> I <br /> E <br /> Describe any on-site or off-site source of odor(e.2.a ricultural wastes : <br /> i <br /> I <br /> j Describe an displacement of peopie that will be caused by the roject e.q.numbers of 2eople, housing units): <br /> 0 n'� <br /> 'i <br /> 'i�� 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) <br /> involved in this application, or <br /> Legal agent (attach proof of tt;e 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 Name: Signature: Date: 3- S <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date., <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F IDEVSVCIPlanningApplication Forms\Use Permit.(Revised 1-2-03) Page 5 of 9 <br />