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C;o-0t) APPLICATION •- USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> Describe any items of historical or archaeological interest on-site e. .cemeteries or structures): <br /> Describe any on-site or off-site sources of noise or vibration(e-g.freeway noise,heavy a ui ment,etc.): <br /> Ts IL <br /> Describe any onsite or off-site sources of light of glare e. .parking lot lighting,or refledive materials used): <br /> De cribe any on-site or off-site source of odor e. .agricultural wastes): <br /> Describe any displacement of people that will be caused by the project e. .numbers of people,housing units): <br /> 14 <br /> AUTHORIZATION'SIGNATURES <br /> ONLY THE OWNER OF THE'ftROPERTY 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 /> 1,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 owners 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. II <br /> —� Print Name: t` Signature: Date: sar-�3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:oEvsvoPlanning Application FormsWse Permit.(Revised 02-0310) Page 5 of 9 <br />