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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.g.cemeteries or structures): <br /> Describe an on-site or off-site sources of noise or vibration(e.g.freewaynoise, heavyequipment,etc. : <br /> I -4p -i - (D D t412 a <br /> e �� t u. ° r <br /> Describe an on-site or off-site sources of light of glare e. .parkinglot lighting,or reflective materials used): <br /> Describe an on-site or off-site source of odor(e.g. agricultural wastes): <br /> ',o - 'AI rn -, u <br /> Describe an displacement of people that will be caused b the ro'ect(e.g. numbers of people, housingunits): <br /> lc <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 /> nr��rP L <br /> Print Name: '��� Signature: ' � Date: <br /> Print Name: _� Signature: , Date: <br /> Print Name. Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.0EVSVCT1anning ApphW6on FonosWw Permit(Revised 02-0370) Page 5 of 9 <br />