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Op4UTIN <br /> APPLICATION - USE PERMIT <br /> („± SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r ,.� FILE NUMBER: UP- <br /> �/PORN <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> CII <br /> Describe any on-site or off-site sources of noise or vibration e. .freeway noise,heavy equipment,etc. : <br /> 'o <br /> Describe any on-site or off-site sources of light of glare(e.g.parldnglot lighting,or reflective materials used): <br /> Describe any on-site or off-site source of odor e. .a ricultural wastes): <br /> Describe any displacement of people that will be caused by the prolect e. .numbers of people,housing units): <br /> / <br /> AUTHORIZATION SIGNATURES <br /> rFemployees <br /> OWNER OF THE PROPERTY P. AN AUTHORIZED AGENT MAY FILE AN APPLICATION. i <br /> /Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> rom 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 trueandcorrect. <br /> Print Name: j��tZZ �lNh Signature: Date: .1'” <br /> Print Name: signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: signature: Date: <br /> F:10EVSVMP1anning Appunatimn Pones\Use Permit(ReNsed 02-0 10) Page 5 of 9 <br />