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APPLICATION - USE PERMIT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Other <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Nolo <br /> Describe an on-site or off-site sources of noise or vibration (e.g.freewaynoise, heavyequipment, etc. : <br /> 4] EW O ! CC <br /> Describe any on-site or off-site sources of light of glare e. .parking lot lighting,or reflective materials used): <br /> 11, W ' Lt(o "-TS 01J $i `t-ar- WiLL j t <br /> aG w T <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> C', lV is <br /> Describe any displacement of people that will be caused by the project e. . numbers of peopie,housing units): <br /> (\t O Li t= <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED 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 /> Print Name: G lif�i�I S tN G tJ Signature: N Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVOPlanning Application Forms\Use Pemit.(Revised 02-03-10) Page 5 of 9 <br />