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APPLICATION - USE PERMIT <br /> 'Q y <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 9�/F ORS <br /> ° FILE NUMBER: UP- <br /> "vn <br /> 0-1 . t CY 3 x{� 5;roti <br /> w.v�' e '•=v*2, rt° x� v; t} ',n"tt" > .> 4 1 a ftf�4km Y 4 aM ..r SvAc pti <br /> Describe any items of historical orarchaeological interest on-site (e.g. cemeteries or structures : <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heayy equipment, etc.): <br /> 1 N f 1' L Va Vr . <br /> Describe an on-site or off-site sources of light of glare e. arkin lot lighting,or reflective materials used): <br /> Describe an on-site or off-site source of odor(e.g. agriculture wastes <br /> Describe an dis lacement of eo le that will be caused b the project(e-q. numbers of people, housingunits <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 Owner/Agent's project. <br /> 1,, further, certify under penalty of perjury that I am (check one): <br /> L$ 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 /> // f <br /> PrintName:�A7�i`t.iAA /'l �rrf• % Signature. Date:-3 <br /> Print Name: ��,[ 'y �Y f�J1�G�-R yl117 Signature: Date: 3—IS—OIo <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> _ RIOUEZ <br /> I NOTARY PO M. AURORK41111 <br /> Sex JOACuie COUNTY <br /> Me '. Erc.0n. Ip,Q <br /> F\DEVSVC\PIanning Application Fonns\Use Peiroit(Revised 1-2-03) Page 5 of 9 Jq <br />