Laserfiche WebLink
I 1 <br /> w' <br /> APPLICATION - USE PERMIT <br /> r.' <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> ` <br /> 10:�1 Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment,etc. : <br /> None <br /> 4 <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting, or reflective materials used): <br /> None <br /> Describe any on-site or off-site source of odor(e.g. agricultural wastes): <br /> f None <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people, housing units): <br /> None <br /> AUTHORIZATION°SIGNATURES. R <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 /> 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 /> i <br /> Print Name: 126i2l vz� Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:1DEVSVC\Planning Application FosmsWse Permit.(Revised 6-03-04) Page 5 of 9 <br />